基于胆囊三角解剖特点设计的"两点提拉法"经脐单孔腹腔镜胆囊切除术的临床应用OA

Objective To explore the application feasibility of a novel"two-point lifting/retracting technique"based on the anatomical features of Calot's triangle for transumbilical single-incision laparoscopic cholecystectomy(SILC).Methods A retrospective analysis was conducted on 103 patients,who were admitted to Pu'er People's Hospital between June 2023 and June 2024.Among these patients,82 cases with gallstones and chronic cholecystitis,6 cases with gallstones and acute cholecystitis,11 cases with gallbladder polyps,4 cases with gallbladder adenomyomatosis.During SILC,a 3-0 absorbable suture was inserted via a right upper quadrant paracostal puncture at the 8th to 9th intercostal space along the midclavicular line,to"lift"the gallbladder fundus upward.A 3-0 absorbable suture was inserted via a 5 to 10 cm subcostal puncture,along the mid-axillary line,to"retract"the gallbladder fundus downward and to the right.All the surgical procedures were conducted with standard laparoscopic instruments.Results The"two-point lifting/retracting technique"was successfully applied in SILC for 98 patients(95.14%),which effectively exposed the Calot's triangle during the operation.The operation time was 35 to 70 min,and the intraoperative blood loss was 2 to 10 mL.For other 5 cases,an additional operation port was required below the xiphoid process in 3 cases,due to severe local gallbladder adhesions;conversion to conventional three-port laparoscopic cholecystectomy in 2 cases,due to acute inflammatory.Postoperative complication for"two-point lifting/retracting technique"SILC such as abdominal pain,fever,bile leakage,hemorrhage,or incisional infection was not found.No discernible surgical scar was observed at 2 weeks after surgery.During the 3-month follow-up period,no complication was found.Conclusion The"two-point lifting/retracting technique"based on the anatomical features of Calot's triangle,facilitates exposure of Calot's triangle during SILC,which is simple and safe and feasible.