Abstract
BACKGROUND Although single incision laparoscopic cholecystectomy is feasible, it is associated with a higher rate of bile duct injury (0.72%) than standard cholecystectomy (0.4–0.5%). The main factor responsible seems be suboptimal exposure of Calot’s triangle due to lack of independent retraction of the gallbladder fundus and infundibulum, especially for a ‘floppy’ fundus/large liver overlapping the extrahepatic biliary tree. Various innovative methods are described for gallbladder retraction. However, they lack the ability of dynamic manipulation. We describe a simple technique of fundal retraction.
Highlights
Single incision laparoscopic cholecystectomy is feasible,[1] it is associated with a higher rate of bile duct injury (0.72%) than standard cholecystectomy (0.4–0.5%).[2]
TECHNIQUE After transumbilical port placement, the gallbladder fundus is grasped with a catgut loop (Fig 1)
This is used to grasp the catgut loop tail in such a way that it locks the jaws of the port closure needle and prevents it from slipping during retraction (Fig 3)
Summary
Paraphimosis is a urological emergency and urgent reduction is required. It can be quite challenging in children as general anaesthesia is usually required to reduce the foreskin. Empty a single tube of EMLA® (2.5% lidocaine and 2.5% prilocaine; AstraZeneca, London, UK) into the sleeve. Advance it over the penis or if the child is anxious, ask the parent to do so. The sleeve provides sufficiently prolonged application of EMLA® for local anaesthesia and allows it to soften the foreskin. The foreskin can be reduced with gentle traction
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