Application of Modified Single-Incision Technique for Fluorescence-Guided Laparoscopic Cholecystectomy

Summary

The manuscript details the steps involved in fluorescence-induced modified single-incision laparoscopic cholecystectomy and discusses its clinical advantages and appropriate indications.

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure for benign gallbladder diseases. With advancements in LC techniques and the ongoing pursuit of minimally invasive surgery, single-incision laparoscopic cholecystectomy (SILC) has emerged to further reduce surgical trauma and postoperative pain for patients. However, while reducing the number of abdominal incisions, SILC introduces several challenges. Conventional single-incision laparoscopic techniques are prone to the chopstick effect, requiring a higher level of surgical skill and a significant learning curve. For surgeons with limited experience in single-port surgery, this may lead to an increased risk of accidental injuries and prolonged operative time. This article outlines the main steps for performing a fluorescence-guided modified single-incision laparoscopic cholecystectomy. The advantages of this modified technique include: the subxiphoid insertion of the electrocautery hook aligns with conventional LC operating practices, effectively overcoming the chopstick effect associated with SILC. This modification shortens the learning curve while reducing both operative time and hemorrhagic complications (with only one case of post-operative fever). Preservation of the minimally invasive benefits of SILC-only the umbilical incision remains, with other wounds healing rapidly. Fluorescence navigation aids in real-time visualization of the biliary tract, further enhancing surgical safety.

Introduction

Gallstones affect approximately 20% of the global population, representing a significant worldwide health burden¹. Cholecystectomy remains the gold-standard treatment for gallstones. Since laparoscopic cholecystectomy (LC) became the mainstream approach in the 1990s, minimally invasive techniques have continued to evolve, particularly over the past decade, driven by innovations in surgical instrumentation and imaging technology².

With the advancement of minimally invasive techniques, single-incision laparoscopic cholecystectomy (SILC) has emerged as a promising approach, offering superior post....

Protocol

Written informed consent has been obtained from the patient for performing this study. This research was performed in compliance with the guidelines of the human research ethics committee of the Fifth Affiliated Hospital of Sun Yat-sen University. All human biological materials and surgical waste were handled in accordance with institutional biomedical waste disposal protocols.

1. Patient selection and preoperative preparation

1. Patient inclusion and exclusion criteria: Include elective patients with benign gallbladder disease who have cosmetic concerns or desire reduced postoperative pain, with ASA class I-II. Ex....

Results

Between August and December 2024, a total of 31 cases of fluorescence-guided modified single-port LC were recorded in our center, with demographic data presented in Table 1. Among these, 28 cases were successfully completed, while 3 cases were converted to conventional multi-port LC (2 due to inadequate exposure of the Calot's triangle and 1 due to severe inflammatory adhesions discovered during the procedure), resulting in a success rate of 90% (28/31). Peri-operative patient outcomes are summarized.......

Discussion

LC is the traditional gold-standard surgical approach for benign gallbladder diseases¹³. With the ongoing advancement of minimally invasive surgical techniques, SILC has emerged, aiming to further reduce postoperative pain and improve cosmetic outcomes for patients^3,14. However, single-incision laparoscopic techniques present several challenges, including the chopstick effect -- caused by the parallel arrangement of instruments through the.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
4-0 Coated VICRYL	ETHICON	VCP310	The Suture Material
Electrocautery Hook	Zhejiang Shiyou Instruments & Equipment Co., Ltd.	SY-IVB-D	Electrocautery Hook
Endoscopic Fluorescence Imaging System	ZHUHAI DI PU MEDICAL TECHNOLOGY CO., LTD.	DPM-ENDOCAM-03	Fluorescence Laparoscope Equipment
Hem-O-lock Clips	SINOLINKS MEDICAL INNOVOATION, INC.	B240714	Hem-O-lock Clips
Indocyanine Green for Injection	DANDONG YICHUANG PHARMACEUTICAL CO., LTD.	H20055881	Fluorescence Dye
Single-Incision Laparoscopic Device	Hangzhou Grand Medical Devices Co., Ltd.	191-JQST4C635	Single-Incision Laparoscopic Device
Single-Use Suture Passer	Jiangsu Anneng Medical Devices (Changshu) Co., Ltd.	ANONG-FB120	Used for gallbladder suspension