Marionette method for transumbilical single-incision, two-trocar laparoscopic cholecystectomy: a new, simple technique.

BACKGROUND/AIMS Single-incision laparoscopic cholecystectomy (SILC) has recently become a topic of interest among types of minimally invasive surgery. METHODOLOGY We developed a novel "marionette method"technique for performing SILC. Two 5 mm trocars were placed through a 1.5 cm transumbilical incision. In addition, a nylon suture with a laparoscopic sliding knot was used to tighten the fundus of the gallbladder and was thereafter suspended with this nylon suture. The neck of the gallbladder was tightened by means of a loop type retractor, to enable adequate visualization of the triangle of Calot. Dissection was performed as a conventional laparoscopic cholecystectomy using standard straight laparoscopic instruments. RESULTS All 20 patients successfully underwent a single-incision, two-trocar laparoscopic cholecystectomy performed using the marionette method. The mean operative time was 119 min. There were no complications. CONCLUSIONS The marionette method can provide good tension and an appropriate laparoscopic view with a suitable surgical field for safely performing a dissection at the triangle of Calot during SILC.