THELDENIYA US GUIDED MINI INCISION CHOLECYSTECTOMY; A NEW TECHNIQUE OF CHOLECYSTECTOMY THROUGH A 5CM INCISION; WITH THE USE OF A WOUND RETRACTOR DEVICE AND ULTRASONIC GUIDANCE kosala.medi@gmail.com

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THELDENIYA US GUIDED MINI INCISION CHOLECYSTECTOMY; A NEW TECHNIQUE OF CHOLECYSTECTOMY THROUGH A 5CM INCISION; WITH THE USE OF A WOUND RETRACTOR DEVICE AND ULTRASONIC GUIDANCE

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Prabodha Iddamalgoda prabo7.pi@gmail.com District Base Hospital Theldeniya Surgery Theldeniya Sri Lanka *

Vishwanath Thennakoon vishaath@gmail.com District Base Hospital Theldeniya Surgery Theldeniya Sri Lanka

Sri Lanka

Oral only

Current standards of care for cholecystectomy is with the use of laparoscope. Yet when that facility is not available or when that fails, standard open cholecystectomy is performed with a sub-costal incision which is generally 10cm - 15cm in length (Kocher's incision), it usually cuts through neuro-vascular bundles. As opposed to that, combined incision length of laparoscopic cholecystectomy is 5-6cm and does not entail any neuro-vascular bundle injury. Here we describe a new technique of cholecystectomy with a 5cm subcostal incision which entails no damage to neurovascular bundles.

Exact position of the gall bladder fundus was marked ultrasonically. Patient under general anesthesia and supine position, a 5cm incision placed along the Langers’ lines centering the fundus. Alexis medium sized wound retractor device placed which provides circumferential retraction. Gall bladder dissected with fundus first approach. From January 2022 to November 2023, fifteen (15) cases were performed. One case was converted to standard Kocher's incision due to difficult access to triangle of Calot's.

All 14 patients made an uneventful recovery. Patients reported a post op pain score of 1, in a scale of 0-4. Had no patches of anesthesia related to the incision. The patient who had standard Kocher's incision reported a pain score of 2 and had a patch of anesthesia related to the incision.

Theldeniya US guided mini-incision Cholecystectomy could be a good trade-off between laparoscopic Cholecystectomy and open standard cholecystectomy. It offers minimal pain, minimal neuro-vascular bundle damage and minimal scarring.