November 10, 2011 - Fast Track articles - First published January 2011

Single-Fulcrum Laparoscopic Cholecystectomy: A Variant Single-Incision and Multiport Technique

Sung Hoon Choi, Chang Moo Kang, Ho Kyoung Hwang, and Woo Jung Lee


Background: Single-port laparoscopic surgery using a natural wound, the umbilicus, has been developed based on accumulated laparoscopic experiences and technique. Because working instruments need different fulcrum points in a narrow incision (umblicus), various types of specialized instruments are generally necessary for performing single-port surgery.1?8

Methods: This technique is a kind of single-incision and multiport technique. However, by using two main working instruments in a single fulcrum point, we can perform single-incision laparoscopic cholecystectomy more effectively without expensive and specialized equipments. After making an incision on the umbilicus, a 10-mm port for the laparoscope was introduced through the upper portion of the wound. A commercialized miniature 5-mm port was inserted through the lower part of incision, and the usual 2-mm port was inserted just below the 5-mm trocar insertion site (these two working ports use the same fulcrum point). Upward and lateral traction of gallbladder was done by applying 2-0 monofilament suture to the fundus percutaneously. With right lateral traction of the gallbladder by a 2-mm grasper, the anterior aspect of Calot's triangle was dissected. After changing the vector of the working port at the single fulcrum, gallbladder was retracted to the left lateral portion to expose the posterior part of Calot's triangle. After isolating and dividing both cystic artery and cystic duct, cholecystectomy was done.

Results: From March 2009 to May 2010, seventy patients underwent this single-fulcrum laparoscopic cholecystectomy. The general characteristics and perioperative outcomes of the patients were summarized. There was no conversion case to conventional laparoscopic cholecystectomy or open surgery. There was no case of drain insertion, complication, or death, even though about 16% of bile spillage was occurred. Cosmetic effect of this single-fulcrum laparoscopic cholecystectomy was similar to the usual one-port technique.

Conclusion: This single-fulcrum laparoscopic cholecystectomy is regarded feasible, safe, and cost effective. Further comparative study between current single-fulcrum laparoscopic cholecystectomy and conventional technique will address the potential benefits of this technique.

The authors would like to express special thanks to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the figures and to Anthony Thomas Milliken (English Editor, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for comprehensive narration of this multimedia article.

Drs. Sung Hoon Choi, Chang Moo Kang, Ho Kyoung Hwang, and Woo Jung Lee have no conflicts of interest or financial ties to disclose.

Runtime of video: 8?mins 45?secs

Cite This Video

Choi SH, Kang CM, Hwang HK, Lee WJ. Single-Fulcrum Laparoscopic Cholecystectomy: A Variant Single-Incision and Multiport Technique. Journal of Laparoendoscopic & Advanced Surgical Techniques and Part B: Videoscopy. First published January 2011.


Sung Hoon Choi, Chang Moo Kang, Ho Kyoung Hwang, and Woo Jung Lee, Single-Fulcrum Laparoscopic Cholecystectomy: A Variant Single-Incision and Multiport Technique, J Laparoendosc Adv Surg Tech Part B Videoscopy. 2011, DOI: 10.1089/vor.2011.0041.

  • 1. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg 1997;84:695.
  • 2. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 1999;9:361?364.
  • 3. Rao PP, Bhagwat SM, Rane A. The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB 2008;10:336?340.
  • 4. Romanelli JR, Mark L, Omotosho PA. Single port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 2008;15:223?228.
  • 5. Gumbs AA, Milone L, Sinha P, Bessler M. Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 2009;13:533?534.
  • 6. Kuon Lee S, You YK, Park JH, Kim HJ, Lee KK, Kim DG. Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech A 2009;19:495?499.
  • 7. Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 2009;13:159?162.
  • 8. Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG. Single port access (SPA) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A 2009;19:219?222.

Author Information

Choi SH, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Kang CM, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea., contact at

Hwang HK, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Lee WJ, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

2012/01/24 06:26 2012/01/24 06:26

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