Laparoscopic cholecystectomy without visible scar. Combined suprapubic and transumbilical approach: the "Minden cholecystectomy".

surgery (NOTES) is a promising technique especially for cholecystectomy. During the last 2 years the combined transvagi− nal and transumbilical approach without visible scars [1] became a real alternative to standard four−trocar cholecystectomy in several institutions [2 ±4]. However, clearly this method cannot be used in men, and there might be psychological or cultural barriers preventing women from agreeing to cholecystectomy through the vagina. Therefore, we devel− oped the Minden method for minimally invasive cholecystectomy by transposing the vaginal approach to a suprapubic po− sition in a region normally covered by pubic hair. In November and December 2008, two women (56 and 49 years old, respective− ly) underwent operations for symptomat− ic cholecystolithiasis. A 308 conventional optic (Karl Storz GmbH, Tuttlingen, Ger− many) was inserted through a 5−mm in− traumbilical trocar. A 10−mm trocar was inserted via a suprapubic incision. The gallbladder was fixed to the abdominal wall by a suture (l" Fig. 1). The infundibu− lum was manipulated by a 5−mm grasper introduced through the suprapubic ac− cess alongside the camera trocar in one patient and by a 2−mm grasper in the sec− ond patient. Following dissection of the Calot’s triangle via the umbilical access, the cystic duct and cystic artery were clipped with a 5−mm multifire clip device (Ligamax 5 Endoclip applier, Ethicon Laparoscopic cholecystectomy without visible scar. Combined suprapubic and transumbilical approach: the “Minden cholecystectomy”