Percutaneous cholecystostomy with locking trocar: How I do it?

Abstract

Cholecystectomy and open cholecystostomy are associated with a high mortality rate in critically ill patients. Ultrasound-guided percutaneous cholecystostomy has a high success rate with few complications. The following method of percutaneous cholecystostomy with locking trocar (LT) under direct laparoscopic vision is seen to be an effective, safe, and practical procedure. After the abdomen is prepared from xiphisternum to symphysis pubis, the umbilicus and surrounding skin are infiltrated with 1% combined lignocaine and adrenaline. A 10-mm laparoscopy trocar is inserted via a 10-mm subumbilical incision. After a camera is inserted via the trocar, the abdomen and gallbladder are exposed. The skin of the geometric projection of fundus is infiltrated with the same solution, and a 5-mm LT is introduced via a 5-mm skin incision directed to the fundus of the gallbladder guided by the direct view of a laparoscope. When the LT has penetrated to the gallbladder, the bile and contents of the gallbladder are aspirated immediately to reduce the pressure, and the trocar is locked. The locked trocar is fixed to the abdominal wall under traction until the completion of peritonization to prevent bile leakage. The gallstones can be extracted through the trocar by a laparoscopy forceps. This technique was used for a 75-year-old woman with calculous cholecystitis and cardiopulmonary insufficiency, and her progress at this writing is good.