Therefore, we strongly recognized the necessity to improve the new SILC technique without using the Abiraterone molecular weight SILS Port. 3. Three-Port Method via Umbilical Incision Next, we selected the 3-port method, which makes use of three 5mm ports (Ethicon, Brunswick, NJ, USA) (Figure 2) via umbilical incision. The same forceps, graspers, or electrical devices were used as when using the SILS Port. This technique was able to shorten the length of the umbilical scar by approximately 5mm in comparison to the use of the SILS Port; however, the conflicts between the operative instruments and the scope and between the surgeon and the assistant were not improved. As a result, it was found that the ideal technique for SILC would involve the insertion of only two ports via umbilical incision and would have the surgeon and the assistant located on opposite sides of the patient.
Figure 2 External view of 3-port LC via umbilical incision. 4. Two-Port via Umbilical Incision A 15mm vertical skin incision was made through the center of the umbilicus. After the fascia was exposed, two 5mm ports were introduced at separate sites, one on the left side for the 5mm laparoscopic flexible scope and one on the right side for a forceps or grasper to dissect the gallbladder. The instruments used in this technique were the same as in the conventional 4-port LC. A 2mm loop-type retractor was inserted from the right subcostal arch to present Calot’s triangle by extending Hartman’s pouch. A nylon suture with a straight needle to which a Roeder knot [10] was added to the end was inserted through a 5mm left side port.
The fundus of the gallbladder was tightened with the Roeder knot, and then the straight needle was inserted from the abdominal cavity to the right subcostal abdominal wall (Figure 3). The gallbladder was elevated by raising this nylon suture, and a good surgical field was obtained (Figure 4). The surgeon operated both one instrument and the 5mm flexible scope by herself, and the assistant made a good surgical field such as Calot’s triangle via the traction of the gallbladder using a fine loop retractor and nylon suture. This technique relieved the interference between the surgeon and the assistant and between the forceps themselves. To extract the exfoliated gallbladder, one 5mm port was removed, and an endoscopic retrieval bag was inserted directly with an original hole, and the gallbladder was then extracted.
No intraperitoneal drainage was used. The fascial defect of the umbilicus incision was repaired with approximately two stitches, and an intradermal suture was performed on the skin. The treatment of the small scar made by the 2mm loop-type retractor and nylon suture was unnecessary. This technique represents minimally invasive surgery that combines low invasiveness and Entinostat with a scarless outcome. Figure 3 External view of 2-port LC.