Performing gallbladder surgery on morbidly obese patients is widely regarded as one of the more challenging scenarios in laparoscopic surgery. At St. Mary’s K Surgery in Incheon, we specialize in single-port laparoscopic cholecystectomy — a minimally invasive technique that uses only one small incision through the navel. In this post, we share a recent case involving a patient with a BMI of 45.7 and a 3 cm gallstone, and walk through how single-port laparoscopy was successfully performed.
Patient Background
A male patient in his late 30s visited our clinic with worsening right upper quadrant pain and severe epigastric cramping after meals. He had been aware of gallstones for some time but had managed the discomfort conservatively — until the symptoms became too severe to ignore.
At 175 cm tall and weighing 140 kg, his BMI was 45.7, placing him in the Class III (morbid) obesity category. While this level of obesity adds significant complexity to any abdominal procedure, our center has extensive experience with single-port gallbladder surgery in high-BMI patients. In fact, we previously operated on a patient who was 185 cm and 150 kg just a few months earlier.
Gallstone disease is more prevalent among individuals with higher body weight, so our surgical team has become well accustomed to managing these challenging cases.
Preoperative Findings
An ultrasound performed at a local internal medicine clinic showed a gallstone estimated at approximately 2 cm. However, the stone turned out to be significantly larger — over 3 cm — once removed during surgery.
This distinction matters clinically: gallstones 3 cm or larger are considered an indication for surgery regardless of symptoms, as they are a recognized risk factor for gallbladder cancer.
Surgical Details
| Date of Surgery | January 16, 2026 |
| Procedure | Single-Port Laparoscopic Cholecystectomy (SILS) |
| Hospital Stay | 3 days / 2 nights |
| Estimated Cost | Approx. 1,750,000 KRW (private room) |
Why Is Gallbladder Surgery More Difficult in Obese Patients?
Obesity itself is a condition associated with chronic low-grade inflammation. When combined with an abdominal procedure like cholecystectomy, several factors increase surgical difficulty:
- Thicker abdominal wall: Accessing the peritoneal cavity through a single umbilical incision requires more effort and precision.
- Extensive adhesions: Chronic inflammation often leads to significant adhesions around the gallbladder and surrounding soft tissues.
- Wider operative field: A larger abdominal cavity means instruments must cover greater distances, making maneuverability more demanding.
Step-by-Step Surgical Process
1. Abdominal Entry and Adhesiolysis
After entering the abdomen through the navel, we found extensive adhesions surrounding the gallbladder. Careful adhesiolysis (separation of adhesions) was performed first, taking approximately 20 minutes due to the severity of the adhesions and the wide operative field.
2. Identification and Ligation of the Cystic Duct
Once the adhesions were cleared, the cystic duct was carefully identified. It was first secured with a Hem-o-lok clip, then reinforced with an additional clip for a double ligation — ensuring a secure seal.
3. Ligation of the Cystic Artery
The cystic artery was also double-ligated. A reactive lymph node was visible just above the vessel — commonly known as the Calot’s lymph node (also called Lund’s node), which is frequently seen in cases of cholecystitis.
4. Gallbladder Dissection from the Liver Bed
The gallbladder was carefully dissected from the cystic plate (liver bed), taking care to avoid any liver injury. Once fully separated, the specimen was placed in a retrieval bag and extracted through the umbilical incision.
5. Final Inspection and Closure
A thorough inspection confirmed there was no bleeding or bile leak. The operative field was clean, and the surgery was concluded.
Specimen and Pathology Results
The extracted gallbladder showed significant wall thickening — a hallmark of chronic inflammation. The stone itself measured over 3 cm, larger than the 2 cm estimated on preoperative ultrasound. The patient received the gallstone as a keepsake.
Final pathology confirmed the diagnosis: chronic cholecystitis.
Recovery and Cosmetic Outcome
The patient was discharged on the second postoperative day. At the one-week follow-up, the umbilical incision site had healed remarkably well — with the surgical scar practically invisible.
This is one of the major advantages of single-port laparoscopic surgery: because the sole incision is made through the navel, patients are left with virtually no visible scarring.
Cost of Single-Port Laparoscopic Gallbladder Surgery
The total cost for this patient — including the procedure, a 3-day/2-night hospital stay in a private room — came to approximately 1,750,000 KRW (roughly 1,300 USD).
At St. Mary’s K Surgery, we perform single-port laparoscopic procedures using conventional laparoscopic instruments rather than expensive robotic systems. This helps keep costs significantly lower while achieving excellent surgical and cosmetic outcomes.
Conditions We Treat with Single-Port Laparoscopy
Our single-port laparoscopy center treats a range of common surgical conditions using this minimally invasive approach:
- Gallstone disease (cholelithiasis) and cholecystitis
- Inguinal hernia
- Appendicitis (appendectomy)
By relying on standard laparoscopic equipment instead of robotic platforms, we are able to offer high-quality single-port surgery at an affordable cost — without compromising on safety or results.
Considering Gallbladder Surgery?
If you are experiencing gallstone symptoms — especially persistent right upper abdominal pain or cramping after meals — we encourage you to consult with a specialist. Even if you have been told that surgery might be risky due to obesity or other factors, single-port laparoscopic cholecystectomy may still be a safe and effective option.
St. Mary’s K Surgery — Single-Port Laparoscopy Center, Incheon, South Korea
