INTRODUCTION
Laparoscopic cholecystectomy is one of the surgeries that can offer a significant advantage over open surgery, and many centers all over the world have converted to laparoscopic methods. Within 5 years from 1990 to 1995, the percentage of cholecystectomies performed laparoscopically increased from 10% to 80% in the USA [1]. However, in rural areas, most of the cholecystectomies are done by the open method. In a study by Dr. Elias Engelking [2], many of the surgeons working in rural areas have a desire to convert to laparoscopic surgeries, but the conversion is impeded by the steep learning curve and non-availability of cost-effective equipment [3].
Lift laparoscopic surgery is a method that has the advantages of sturdy instruments and lower costs, and it is easier to learn. We describe the method of doing lift laparoscopic cholecystectomy that we demonstrated at a live workshop in Midnapore Medical College.
METHOD
The portion of the lift apparatus that attaches to the table is fixed at the level of the right shoulder. The patient is positioned prone, with lateral supports. A 2-cm vertical incision is made at the lower part of the umbilicus and is widened to comfortably pass the index finger.
The intra-abdominal portion of the lift is inserted carefully anticlockwise, and it is then fixed to the lift apparatus. The anterior abdominal wall is lifted under vision making sure that there is no omentum or bowel between the lift and the anterior abdominal wall.
Two 5-mm ports are placed on either side of the lifting ring—one in the midaxillary line on the right side and one in the midclavicular line on the left side. Figure 1 shows the placement of the ports, and Figure 2 shows the surgery in progress.
| Figure 1: The incision and port sites | Figure 2: Surgery in progress |
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The camera and another instrument can be comfortably passed through the umbilical incision. The gall bladder is dissected using a combination of laparoscopic and long open surgical instruments.
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