Single-port technique gallbladder surgery | Doctors

The single-port technique in gallbladder surgery refers to a minimally invasive procedure via a single incision in the abdominal wall. There are currently four single-port systems or techniques available that are suitable for removing the gallbladder using the keyhole technique. Here you will find further information as well as selected specialists and centers for the single-port technique in gallbladder surgery.

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Single-port cholycystectomy - Further information

Definition: Single-port technique for gallbladder surgery

The removal of the gallbladder using the single-port technique refers to the laparoscopic removal of the gallbladder via a single small access. This means that neither a long abdominal incision nor several small incisions are necessary.

Laparoscopy is a form of minimally invasive surgery using the "keyhole technique". This incision is usually located in the area of the navel for gallbladder removal using single-port surgery.

The so-called NOTES technique ("natural orifice transluminal endoscopic surgery") must be distinguished from the group of single-port techniques. This leaves no external scars at all, as the surgeon uses a natural body opening as an access point. However, this does involve cutting through (perforating) a healthy organ, with all the associated risks.

With this technique, surgical access is via

  • mouth,
  • anus,
  • vagina or
  • urethra.

Anatomy of the gallbladder

The gallbladder is embedded in a hollow on the underside of the liver. The main function of the gallbladder is to store and thicken the bile produced by the liver. The bile is mainly used to digest fats in the intestine.

The gallbladder is divided into several parts:

  • the gallbladder floor,
  • the gallbladder body and
  • the neck of the gallbladder.

The neck of the gallbladder merges into the gallbladderduct (ductus cysticus). A spiral-shaped fold of mucous membrane (Heister valve) is located in the transition area. It performs a sealing function, particularly when the pressure in the abdominal cavity increases (e.g. during a bowel movement).


© Henrie / Fotolia

The gallbladder duct joins with thecommon bile duct from the liver(ductus hepaticus communis) to form the common bile duct(ductus choledochus). The common bile duct runs together with the important blood vessels (portal vein and main hepatic artery) in a commonligament (hepatoduodenal ligament). These two vessels supply the liver with blood.

The common bile duct usually flows into the duodenum together with thepancreatic duct.

The gallbladder is supplied with blood via the gallbladderartery (cystic artery). It branches off from the right branch of the main hepatic artery.

Indications for single-port surgery of the gallbladder

The main indications for removal of the gallbladder using the single-port technique are complaints caused by gallstones, such as

  • Pain in the right upper abdomen,
  • biliary colic and
  • feeling of pressure.

Other causes for removal of the gallbladder can be

  • acute inflammation of the gallbladder with or without gallstones,
  • a so-called shrunken gallbladder and
  • a gallbladder polyp

can be. Removal of the gallbladder is rarely necessary in the case of pancreatitis or gallbladder cancer.

Currently available single-port systems

The single-port techniques currently available include

  • Triport (Olympus)
  • SILS-Port (Covidien)
  • X-Cone-Port (Karl Storz)
  • TULC technique (total umbilical laparoscopic cholecystectomy)

Triport single-port system (Olympus)

An incision about 15 mm long below the navel is required to insert this single-port system.

After incision of the skin and opening of the peritoneum, the flexible tubular foil part of the system is inserted into the abdominal cavity. The surgeon attaches the system to the inside of the peritoneum with a flexible rubber ring by pulling back the foil. A special retaining ring is also used for fixation. This completes the installation of the Triport system.

It has one 10 mm and two 5 mm trocar channels with attached valves and a connection for gas supply. A trocar is an instrument used in minimally invasive surgery to keep an access open for the duration of the operation.

Trokar in der minimal-invasiven Chirurgie
Trocar for use in laparoscopy © Yakobchuk Olena | AdobeStock

This single-port system is a disposable product. Special straight or curved surgical instruments are required for the operation.

SILS-Port single-port system (Covidien)

To insert this single-port system, an incision about 20 mm long is required below the navel. The SILS port is a soft but dimensionally stable single port that resembles a wide, short dumbbell.

After incision of the skin and opening of the peritoneum, the lower part of this single port is compressed and inserted into the abdominal cavity. Due to its dumbbell shape, the single-port system automatically anchors itself to the inner peritoneum and the outer abdominal wall.

The SILS port has no built-in valves, so the three openings must be filled with 5 mm or 10 mm valve sleeves.

Standard straight or curved instruments can be used with this single-port system. This system is also a single-use product.

Single-port system X-Cone-Port (Karl Storz)

The insertion of this single-port system requires an incision approximately 20 mm long below the navel. It is a reusable metal instrument consisting of two conical half-shells. These half-shells each have a semicircular, angled hook at the lower end.

After incising the skin and opening the peritoneum, the two hooks are placed together and pushed into the abdominal cavity like a trocar. By bringing the half shells together, the hooks are spread apart so that the X-Cone is held in position.

A rubber cap is then placed on the abdominal wall to seal it. It has five valved access ports and a gas connection on the side.

Standard straight or curved instruments can also be used with this single-port system.

TULC technique (total umbilical laparoscopic cholecystectomy)

TULC is also a single-port technique. It does not require any special single-port systems. A skin incision of around 20 mm is made. A Verres needle is inserted through this incision and the abdominal cavity is then inflated with carbon dioxide. In this way, more space is available for the operation and the surgeon can see better.

A regular 12 mm safety trocar and a 5 mm working trocar are then inserted into the abdominal cavity via the Verres needle. The safety trocar is a single-use product, the working trocar is reusable.

Instrumente für mininmal-invasive Eingriffe
Instruments for use in minimally invasive surgery © Nattawat | AdobeStock

Complications of single-port surgery to remove the gallbladder

The removal of the gallbladder using the "keyhole technique" (laparoscopic cholecystectomy) is currently the gold standard in Germany. The procedure is very safe and has a very low complication rate.

The possible complications of removing the gallbladder using the single-port technique depend crucially on various factors , such as

  • Secondary diseases of the patient,
  • secondary diseases due to the gallbladder disease and
  • whether the operation is planned or an emergency operation.

In addition to general surgical risks such as

  • Bleeding,
  • post-operative bleeding,
  • infections,
  • wound healing disorders or
  • thrombo-embolisms

Injuries to the bile ducts or neighboring organ structures are extremely rare. Possible intraoperative complications may very rarely necessitate a switch to an open surgical procedure.

The complication rate of single-port cholecystectomy corresponds to that of laparoscopic cholecystectomy. However, the following occur less frequently

  • Wound healing disorders,
  • postoperative pain and
  • possible incisional hernias

occur less frequently.

Life without a gallbladder is possible without any impairment. The quality of life without a diseased gallbladder is higher than with a diseased gallbladder.

Conclusion on the single-port technique

All four single-port systems and techniques listed are suitable for removing the gallbladder using the "keyhole technique".

The individual systems have specific advantages and disadvantages due to their different functions and designs. All of these listed surgical methods for removing the gallbladder are safe procedures with the best possible postoperative and cosmetic results.

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