In this photograph, the assistant pulls a nylon suture with his … Figure 4 The nylon suture elevates the gallbladder and a fine loop-type retractor pulling the infundibulum presents Calot’s triangle. Another advantage of this technique is that it is inexpensive, as the instrumental cost could be reduced by approximately 170US dollars in comparison with the conventional 4-port LC. As another further info advantage, when cholecystectomy by means of this 2-port technique is difficult due to severe inflammation or intraperitoneal adhesion, we could immediately shift to conventional 4-port LC using the same instruments. More specifically, the right side 5-mm port inserted via the umbilical incision would be withdrawn and reinserted via the processus xiphoideus below, and an additional 5mm port would be introduced in the right subcostal area.

A 2mm loop-type retractor could be used to lift the gallbladder. By this technique, conventional LC can be performed. The air leak from the foramen after the 5mm port is withdrawn is small. This simple transition is also a great advantage of our 2-port technique because it can be made in any case of cholecystitis or intraperitoneal adhesion. 5. Discussion With the global expansion of the use of SILC, large series of cases have been reported in many institutes. Curcillo et al. reported in their multi-institutional 297-case series that the use of an additional port outside the umbilicus occurred in only 34 cases, and they concluded that SILC was safe and might serve as an alternative to multiport therapy with fewer scars and better cosmesis [11].

Erbella and Bunch surprisingly reported that their mean operative time was 30min (from 22 to 75min) in 100 consecutive SILC cases [12]. Rivas et al. reported that they had observed surgeons in training and found that experienced laparoscopic surgeons might not need to undergo a steep learning curve, and they concluded that SILC was becoming the standard procedure for most elective patients with gallbladder disease [13]. Other reports also concluded that SILC was safe [14, 15]; however, Hernandez et al. reported that biliary complication (cystic duct stump leak) occurred in one of 100 SILC cases [16], and Edwards et al. described that biliary complications occurred in 3.7% of their SILC patients (cystic duct stump leak; 1, accessory duct leak; 2) [17].

Moreover, iatrogenic combined bile duct and right hepatic artery injury during SILC has already been reported [18], and the authors recommended that surgeons should have a low threshold to add additional ports when necessary to ensure that procedures were completed safely, especially in their initial stages. As described, SILC is a useful technique; however, it is necessary to assure that the procedure is as Cilengitide safe as conventional 4-port LC.