A 5mm 30�� Endo-EYE surgical videoscope (Olympus, Tokyo, Japan) is used for visualization of the entire operation. Prolene suture with straight www.selleckchem.com/products/ganetespib-sta-9090.html needle is introduced percutaneously at the right hypochondrium and is made to pierce the gallbladder at the seromuscular plane before exiting the peritoneal cavity at the right hypochondrium (Figure 1); care is taken not to pierce through the mucosa to prevent bile spillage. This serves as a retraction suture to facilitate the exposure of the Calot’s triangle and subsequent dissection. Figure 1 Hanging suture place at gallbladder fundus. An articulating endoforcep, Roticulator (Covidien, Dublin, Ireland), is introduced to provide lateral retraction of the gallbladder, and careful dissection to achieve critical view of safety is then completed (Figure 2).

Figure 2 Articulating forcep used to retract Hartmann’s pouch to expose Calot’s triangle and critical view of safety is visualized. Both the surgeon and the assistant will be on the patient’s left if the patient is on supine position, whereas the operating surgeon will be standing between patient’s legs and the assistant will be on the patient’s left side if the patient is on split-leg position. The assistant would sit in front of the surgeon. In most parts of the surgery, he will be providing gentle lateral traction of the gallbladder by manipulating the Roticulator while the primary surgeon holds the EndoEYE and the dissecting instruments in the ��snooker cue guide�� position (Figure 3).

This position allows the camera and the dissecting instrument to move in a coordinated fashion to ensure optimal visualization of the dissecting process which is critical in safely exposing the Calot’s triangle to identify the cystic artery and duct. Fivemm Hem-o-lock (Teleflex Medical, USA) clips are used to ligate both cystic artery and duct before they are divided between clips. Gallbladder is then placed into a self-constructed bag intracorporeally and removed from the abdominal cavity; fascia is closed with nonabsorbable suture in figure-of-eight fashion, and skin is closed subcuticularly. Figure 3 ��Snooker cue guide�� position. 3. Results One hundred and nineteen patients who underwent SILC for their gallbladder diseases between April 2009 and August 2011 by 2 HPB consultants (Surgeons A and B) were retrospectively studied.

One hundred and nineteen cases were performed by Surgeons A and B, respectively. 7 (5.8%) cases were acute cholecystitis and 75 cases (94.1%) were chronic cholecystitis. Diagnosis of gallbladder disease was achieved by clinical information and pre-op radiological investigations (ultrasound scan or CT scan). There were 8 cases (6.7%) that needed extra working port(s) to complete the procedure; no open conversion was needed in our experience. 3.1. Learning Curve of SILC We defined acceptable conversion rate of SILC as 5% after learning curve is overcome AV-951 as this is considered traditionally an acceptable conversion rate in CLC.