STRANIERO colicistectomia single port

you can tell me something about the procedure you are going good afternoon good afternoon yeah

so we have another case uh right now we have a woman 61 year old with chronic calculus

She had a chronic pain in five years in the right upper quadrant of the type of biliac

colic.

During ultrasound research, we found a concrement of 22 millimeter and a few smaller ones.

So that's why we will perform laparoscopic trilatistectomy through a single-part incision.

Everything is okay?

Okay, very good. And the first question, do you perform always one-part colistectomy?

Nope. We perform such kind of operation only in the case of a big concrement or big diameter.

So in this case the diameter is more than 20 millimeters so that's why

if we will perform a traditional laparoscopic trolecystectomy so we have to do an incision

to extract this concrement up to two centimeters.

So that's why we perform a seal cystectomy.

It's only with cosmetic results.

So the first point, we did an omega-shaped incision

in the parumbilical region.

We always put stitches on fascia

later it will be easier to close the incision like the hernioplasty with the umbilical hernia.

So next step we breed the abdominal muscles and cut the fascia in the horizontal direction

first point is that they put special plastic bag in abdomen before we start

the operation we think that it will save us a few minutes a little bit later we

We will use Sealsport Covedian company today.

Yeah, it's soft with three work chokers with 5mm and one special point to insufflate or

desufflate the gas.

In our point of view, the main benefit of using this port is that it allows to input

and output the spot a few times during the operation especially if we speak

about colorectal surgery the next point is because of its really soft we don't

have the problem with the free working space during the operation so our hands

are always as we called it flying so it's really easy to work with this pot

five millimeter trowel cars these special white things is to desufflate the

gas from the abdomen so we start with three five millimeter trowel cars we

introduce it one by one here we will put an optic then here optic one more

time left hand left hand right hand so uh so it's for desufflating the gas and and for smoke

evacuation so we change the position of a patient in trendling book position oh sorry to the folder

lobe of the liver the right lobe and the gallbladder the first step in the operation we

put a special cage in the abdomen we use a straight needle we put in the right quadrant

separation and we will sue the fundus of the gallbladder to fix it in the right position

to the anterior abdominal wall so here it could be the focus of endometriosis so we will take the

biopsy from this region. Dissection is performed always with a monopolar hook.

And it seems to be a standard hook and not a curved instrument, is it right?

Yeah, it's rigid, straight monopolar hook. So we think that for optimal condition during

the operation one instruments have to be curved and another one it's better to use straight rigid.

because it will help us in the traction of gallbladder when we will work on the anterior

or posterior wall of the gallbladder.

So we cut it with the same way in short actions with monopolar.

Here we find gallbladder ductus.

so here you can see there a little yeah we say we can see clearly and in my opinion the best

way to perform on porcite single port surgery is to perform the same things on the dart and

artery as we generally do in other laparoscopic approach and did you put normally only one stitch

stitch to track the gallbladder only on the right side because I've seen other surgeons

putting also another stitch in the middle part to lift up the gallbladder like a puppet.

We put in this case just one stitch but sometimes if it's really necessary we can put another

we change one five millimeter port to 10 millimeter to clip the duct and the artery

it's possible to to put a clip with a five millimeter clip applicator through a five

millimeter port but in this case you see that the t-stick duct is really wide that's why we

always during this stage of operation because here you see that all tissues are stretched.

of operation before we cut the gallbladder so you see that the liver bed is really dry

About this foci, we check one more time an MRI of the liver, it's hemangioma of the liver,

so we think that we will go without biopsy.

We always perform an antibiotic prophylactic.

plastic. We never use drain in the abdomen and the patients will go home the next day

after the operation. So everything is dry, the operating field is okay. So we can extract

the gallbladder in a plastic bag. Just a few minutes more during the operation and we will

will show you how we close the incision.

Firstly, we remove all the trochars from the seal spot,

and then we remove the pot with a gallbladder.

And now you see these stitches

so that they are put on the fascia.

At the start of the operation,

it will help us to close the abdominal wall

very intelligent and faster.

We close the fascia cut in a cross direction with the single stitches with an absorbable thread.

We always put all the layers of abdominal wall in our hands.

So the needle is about three to four...

hidden hidden stitches yeah so the operation is finished mission complete

okay thank you thank you after your procedure I'm changing my my idea on

single port approach it's great great news for us yeah yeah thank you very

much that's complex from from here and the audience and I hope to see you

tomorrow again about tomorrow thousand excuses but the other patient we planned

for for tomorrow operation we have some complications with why we can't take it

to the operating room thank you thank you so much hopefully see you next year

Yeah, sure.

Yeah.

Thanks a lot.

Thanks a lot.

Bye-bye.

We had a great pleasure.

Yeah.

Bye.

Thank you.