Single Port Robot Assisted Laparoscopic Cholecystectomy

Pier C. Giulianotti (Chicago – USA) Subhashini Ayloo (Newark – USA) Luca Milone (New York City – USA)

Disease: chronic gallbladder stones

Age: 25

ASA score: 1

History: symptomatic gallbladder stones

Description: Patient has been diagnosed with a chronic gallstone cholecystitis that is symptomatic. Single port positioning: an incision is made in the umbilicus and the dissection was carried through the fascial layer until the abdomen is entered. After that we inserted the single port device. The robot is docked from patient right shoulder and nd proper protocol is followed to place the camera cannula and then the curved cannulas under direct visualization while the abdomen is insufflated through the port. A first assistant cannula is placed as well and the robotic arms were attached and using a grasper and a hook with the first assistant retracting the fundus of the gallbladder.
Steps:
1 – After visualizing the confluence of the cystic duct into the common bile duct the cystic duct is Hem-O-locked. This confluence is made clearer using the Fluorescence, that is very helpful in making the identification of the junction between the cystic duct and the main bile duct.
2 – The artery is identified and, using 2 clips, is controlled and transected in between.
3 – Next the gallbladder is dissected retrograde and antegrade from the liver bed.
The robot is undocked, specimen retrieved and the cannulas removed. The umbilical fascial incision is closed with interrupted figure of eight with absorbable material, and also the subcutaneous tissue layer is closed with interrupted stitches, and finally, intradermic suture is done to approximate the skin.