Application of Modified Single-Incision Technique for Fluorescence-Guided Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) is the gold standard surgical procedure for benign gallbladder diseases. With advancements in LC techniques and the ongoing pursuit of minimally invasive surgery, single-incision laparoscopic cholecystectomy (SILC) has emerged to further reduce surgical trauma and postoperative pain for patients. However, while reducing the number of abdominal incisions, SILC introduces several challenges. Conventional single-incision laparoscopic techniques are prone to the chopstick effect, requiring a higher level of surgical skill and a significant learning curve. For surgeons with limited experience in single-port surgery, this may lead to an increased risk of accidental injuries and prolonged operative time. This article outlines the main steps for performing a fluorescence-guided modified single-incision laparoscopic cholecystectomy. The advantages of this modified technique include: the subxiphoid insertion of the electrocautery hook aligns with conventional LC operating practices, effectively overcoming the chopstick effect associated with SILC. This modification shortens the learning curve while reducing both operative time and hemorrhagic complications (with only one case of post-operative fever). Preservation of the minimally invasive benefits of SILC-only the umbilical incision remains, with other wounds healing rapidly. Fluorescence navigation aids in real-time visualization of the biliary tract, further enhancing surgical safety.