Clarification: The Question Appears to Contain a Terminology Error
The term "bilectomy" does not exist in standard surgical nomenclature. Based on the context provided, you are likely asking about laparoscopic cholecystectomy (gallbladder removal), not "bile removal surgery."
Standard Laparoscopic Cholecystectomy Uses Multiple Small Incisions, Not Two Back Incisions
Traditional laparoscopic cholecystectomy does not involve two incisions in the back—it uses 3-4 small incisions in the anterior abdomen (front of the body). 1
Standard Port Placement for Laparoscopic Cholecystectomy:
- One umbilical incision (typically 10-12mm) for the camera 2, 3
- One subcostal incision in the right upper quadrant (5mm or 3mm) 2
- Two additional anterior abdominal incisions for grasping and dissecting instruments 3
The procedure is performed entirely through the front of the abdomen, with the patient positioned supine (lying on their back). 1
Alternative Minimally Invasive Approaches
Double Incision Laparoscopic Cholecystectomy (DILC):
- Uses two anterior incisions only: three 5mm trocars through the umbilicus and one 3mm subcostally on the right 2
- This reduces the standard four incisions to effectively two sites 2
- Still performed from the front of the abdomen, not the back 2
Single-Incision Laparoscopic Cholecystectomy:
- Uses only one transumbilical incision (through the belly button) 3, 4
- Associated with improved cosmesis and shorter length of stay compared to traditional four-incision approach 3
- Requires slightly longer operative time (65 vs 51 minutes) but maintains comparable safety 3
Common Pitfall to Avoid
There is no standard cholecystectomy technique that uses posterior (back) incisions. If you encountered a case with back incisions, this would be highly unusual and might represent:
- A conversion to open surgery with an atypical approach
- A combined procedure addressing a different pathology
- Misidentification of the surgical site
The Critical View of Safety must be achieved through anterior abdominal access by clearing the hepatocystic triangle and visualizing only two structures entering the gallbladder. 1 This anatomical requirement necessitates anterior approach, making posterior incisions impractical for standard cholecystectomy.