Two-point lifting/retracting technology for transumbilical single-port laparoscopic cholecystectomy based on the anatomical features of Calot's triangle.

Background: Among the rapidly developing single-incision laparoscopic cholecystectomy (LC) techniques, transumbilical single-incision LC is increasingly replacing the traditional LC, with advantages of minimal invasion, slight postoperative pain, faster recovery. Despite the advantages mentioned above, the currently available specialized single-port laparoscopic instruments are hindered by high costs and limited applications, challenging their widespread use in medical facilities.

Aim: To design a two-point lifting/retracting (TPLR) technique for transumbilical single-port LC (TUSPLC) based on the anatomical features of the Calot's triangle (or cystohepatic triangle) and investigate its surgical feasibility.

Methods: The clinical data of 103 patients who underwent TUSPLC utilizing the TPLR technique in the Department of Hepatobiliary Surgery at our hospital between June 2023 and June 2024 were retrospectively analyzed. The patient cohort included 82 cases of cholelithiasis, 11 cases of gallbladder polyps, 6 cases of concurrent gallstones and polyps, and 4 cases of gallbladder adenomyomatosis.

Results: All the surgical procedures were conducted using standard laparoscopic instruments. Surgery was successful in 98 (95.14%) patients using the TPLR method, which effectively exposed the Calot's triangle during surgery. The operative time ranged from 35 to 70 minutes, with an average of 42.4 ± 26.8 minutes. In 3 cases, an additional operative port was required below the xiphoid process, and 2 cases were converted to conventional three-port LC. No complications such as abdominal pain, fever, bile leakage, hemorrhage, or incisional infection were noted postoperatively. No discernible surgical scars were observed at the 2-week postoperative reexamination. Additionally, a 3-month follow-up period revealed no complications.

Conclusion: The TPLR technique, developed based on the anatomical features of the Calot's triangle, facilitates exposure of the Calot's triangle during surgery. It is a simple, safe, feasible, and cost-effective method, and a promising approach for single-port LC.