UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

Transcylindrical Cholecystectomy for the Treatment
of Cholelithiasis and Its Complications: Cholecystectomy Under Local Anesthesia
Before reaching a working position of the cylinder, this is gently moved inside of the
abdomen. The blunt shape of the plunger end, slightly protruding from the intra-abdominal
side of the cylinder, facilitates this movement. The plunger can be withdrawn and
reintroduced as many times as necessary to identify anatomical structures. Lamp lights
usually suffice to illuminate the operative field, but a cold light may be of help occasionally.
Fig. 5. View of the hepatocystic triangle through the plug
Part of the gallbladder with its infundubulum is visible at the bottom of the cylinder, as well
as the omentum, duodenal bulb or colon. The infundibulum or Hartmann Pouch is grasped
with tissue Foerster forceps and is drawn anterior and laterally and a medium swab inside
the cylinder is used to displace the organs that impede the sight of the angle between the
gallbladder and the hepatoduodenal ligament. Afterwards the hepatocystic triangle is
dissected using conventional material (Figure 6).
The peritoneum is incised on the hepatocystic triangle, close to the gallbladder neck, and the
fat is carefully dissected away on the free edge of the angle between the infundibulum and
the hepatoduodenal ligament using gauze pledget held in an other Foerster forceps, until
the cystic duct (Figure 7) and common bile duct are clearly defined (no always this later).
Afterwards, we check that the cystic duct follows clearly from the gallbladder neck. If the
cystic duct lymph node and cystic artery are not yet visible, the dissection is done gently
upwards to discover the cystic artery, which will be followed up to its entrance into the
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