E-NOTES Transumbilical Cholecystectomy

Laparoscopic cholecystectomy has become the gold standard for the symptomatic gallbladder lithiasis. Usually, the procedure is performed using 4 trocars. Reducing the number of trocars is one of the ways of minimizing the invasiveness of this procedure. Single port laparoscopy through the umbilical scar, also known as “embryonic natural orifice transumbilical endoscopic surgery” (E-NOTES) was developed as an attempt to improve the aesthetic aspect after surgical procedures and to reduce the morbidity of minimally invasive surgery.

We report a case of transumbilical laparoscopic cholecystectomy without the use of clips, for symptomatic gallbladder lithiasis, the sealing of the cystic duct and cystic artery being obtained by using a LigaSure 5 mm. A 35 year old young male with history of pain in the upper abdomen and right upper quadrant, nausea and vomiting was diagnosed with gallbladder lithiasis after an ultrasound examination. The gallbladder was of normal size, with multiple gallstones. Under general anesthesia, a pneumoperitoneum was created. Three trocars were inserted into the peritoneal cavity for this intervention through the SILS port, through a single incision at the umbilical scar. The cholecystectomy was performed in a retrograde manner. One subhepatic drainage tube was inserted. The operative time was 50 min. There was no intra- or postoperative complications. The patient was discharged in the second postoperative day after a normal course. The 1 month follow-up was normal.