PHN Bag Technique for Laparoscopic Gallbladder Removal: Step-by-Step Guide

Percutaneous Harvest Needle (PHN) Bag Technique

A novel specimen retrieval method for laparoscopic cholecystectomy using a single subcostal incision, reducing trocar-site hernias and improving cosmesis.

Key Steps

1. Prepare Specimen Bag: Commercial retrieval bag with drawstring closure.
2. Trocar & PHN Placement: Insert trocar in subcostal region; introduce Percutaneous Harvest Needle (large-bore atraumatic needle) into gallbladder.
3. Gallbladder Decompression: Evacuate bile/stones via PHN.
4. Bag Introduction: Pass empty retrieval bag through trocar sleeve into peritoneal cavity.
5. Containment: Maneuver collapsed gallbladder into bag; ensure complete encapsulation.
6. Retrieval: Close drawstring; withdraw bag + gallbladder through subcostal incision.
7. Closure: Suture/close subcostal port.

Advantages Over Multi-Port Techniques

• Fewer Port Sites: Single incision → lower trocar-site hernia risk.
• Better Cosmesis: One hidden subcostal scar vs. multiple visible ports.
• Less Specimen Handling: Direct bagging minimizes bile spillage.
• Cost-Effective: Fewer disposable trocars/bags.
• Easier Learning Curve: Simpler than multi-bag techniques.

Limitations

• Not suitable for very large, inflamed, or adherent gallbladders.
• Requires PHN device availability.
• Surgeon experience with single-incision laparoscopy needed.