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A Randomized Trial of Low-Pressure (08–10 mm Hg) vs. Standard-Pressure (13–15 mm Hg) Pneumoperitoneum in Laparoscopic Cholecystectomy. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Almahjoub A, Elfaedy O, Mansor S, Rabea A, Abdulrahman A, Alhussaen A. Mini-cholecystectomy versus laparoscopic cholecystectomy: a retrospective multicentric study among patients operated in some Eastern Libyan hospitals. Turk J Surg 2020; 35:185-190. [PMID: 32550326 DOI: 10.5578/turkjsurg.4208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/21/2018] [Indexed: 11/15/2022]
Abstract
Objectives This study was conducted to analyze the difference between Mini-Cholecystectomy (MC) and Laparoscopic Cholecystectomy (LC) in terms of feasibility and postoperative outcomes to determine if MC could be accepted as a good alternative procedure to LC. Material and Methods A retrospective comparative study of 206 consecutively operated patients of chronic cholecystitis (138 LC and 68 MC), in Al-Jalaa, Ajdabiya and Almrg Teaching hospitals between January 2014 and December 2015 was performed. All cases within the two groups were balanced for age, sex, co-morbidities, ultrasound and intraoperative findings. Exclusion criteria were acute cholecystitis, preoperative jaundice, liver cirrhosis, suspicion of malignancy, previous upper abdominal surgery and pregnancy. Results Mean age of the patients in the study was around 37 years. Female patients represented 88.84%. Intraoperative complications occurred in about 2% of the patients with bleeding in three cases (one in MC, two in LC) and injury to the bile ducts occurred in one case who underwent LC. Operative duration was longer in LC (mean values 64 minutes for LC and 45 minutes for MC). Rate of conversion to classical cholecystectomy in LC was 5% while it was 0% in MC. Only one case of wound infection was registered in the LC group. Postoperative hospital stay was insignificantly longer for LC versus MC (1.97 days for MC and 2.63 days for LC). Conclusion Mini-cholecystectomy is a feasible technique, which can be considered as a good alternative method for gallbladder removal for surgeons who have no experience with laparoscopic techniques and in peripheral hospitals where LC is not available.
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Affiliation(s)
- Aimen Almahjoub
- Department of General Surgery, Benghazi University, Al-jalaa Teaching Hospital, Benghazi, Libya
| | - Osama Elfaedy
- Department of General Surgery, St. Lukes Hospital, Kilkenny, Ireland
| | - Salah Mansor
- Department of General Surgery, Benghazi University, Al-jalaa Teaching Hospital, Benghazi, Libya
| | - Ali Rabea
- Department of General Surgery, Benghazi University, Al-jalaa Teaching Hospital, Benghazi, Libya
| | - Abdugadir Abdulrahman
- Department of General Surgery, Ajdabiya University, Ajdabiya Teaching Hospital, Ajdabiya, Libya
| | - Almontaser Alhussaen
- Department of General Surgery, Benghazi University, Almrg Teaching Hospital, Almrg, Libya
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Abaid RA, Zilberstein B. Two-Incision Laparoscopic Cholecystectomy: Reducing Scars in a Simple Way. J Laparoendosc Adv Surg Tech A 2017; 28:7-12. [PMID: 28514179 DOI: 10.1089/lap.2017.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health. OBJECTIVE To describe a two-incision laparoscopic cholecystectomy (TILC) technique using only conventional material, without increasing complications or operative time. MATERIALS AND METHODS A consecutive and prospective case series compared to another historical operated by conventional laparoscopic cholecystectomy (LC). The TILC was performed with three trocars in two incisions, two trocars in umbilical incision, and one in epigastrium. RESULTS A total of 72 patients were operated on by the same surgeon (36 in each group). There were no significant differences between groups for gender, mean age, body mass index, or length of hospital stay. The procedures were classified by the surgeon according to surgical difficulty and 58.3% (n = 42) were considered low grade, 9.7% (n = 7) difficult, and the other were intermediaries, with no difference between the series (P < .05). There were minor complications in 6.94% (n = 5) procedures. There were no differences between mean operative time (P = .989), which was 49 (95% confidence interval [CI] 42-56) minutes in LC and 40 (95% CI 35-44) min in TILC. There was no need for additional trocars in any case or for conversion to open surgery. CONCLUSIONS TILC is feasible, safe, and with good aesthetic result, using the same instruments of LC, without increasing operative time.
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Affiliation(s)
- Rafael Antoniazzi Abaid
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
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Li YP, Wang SN, Lee KT. Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes. Kaohsiung J Med Sci 2017; 33:201-206. [PMID: 28359408 DOI: 10.1016/j.kjms.2017.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 01/27/2023] Open
Abstract
Conventional laparoscopic cholecystectomy (CLC) is currently the standard of surgical procedure for gallstone disease. Robotic cholecystectomy (RC) has revolutionized the field of minimally invasive surgery; it is safe and ergonomic, but expensive. The aim of this study is to compare the medical resource utilization and clinical outcomes between the two procedures. This study was conducted retrospectively by assessing data of the clinical outcomes and medical resource of 78 patients receiving RC and 367 patients receiving CLC. We reviewed the data of operation times, length of hospital stay, hospital charges, outpatient department visits, outpatient department service charges, and postoperative complications, which were retrieved from the health information system (HIS) database in this hospital. Patients in both groups had similar demographic and clinical features. The RC group had longer length of hospital stay (p=0.056), significantly longer operation time (p=0.035), and much more hospital charges (p=0.001). The RC group, however, experienced less postoperative complication rates (average 3.8% vs. 20.4%, p=0.001). Conversion rate was 1.9% in the CLC group versus 0% in the RC group (p=0.611). Most complications were mild, and following the Clavien-Dindo classification, there were two cases (2.5%) Grade I for the RC group; 50 cases (13.6%) Grade I and 14 cases (3.81%) Grade II for the CLC group (p<0.001 and 0.001, respectively). Procedure-related complications of Grade IIIa status were encountered in nine patients (2.45%) in the CLC group and none in the RC group (p=0.002).The RC group consumed more medical resources in the index hospitalization; however, they experienced significantly less postoperative complications.
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Affiliation(s)
- Yu-Pei Li
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shen-Nien Wang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - King-Teh Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Wang XX, Zhou Q, Pan DB, Deng HW, Zhou AG, Guo HJ, Huang FR. Comparison of Postoperative Events between Spinal Anesthesia and General Anesthesia in Laparoscopic Cholecystectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9480539. [PMID: 27525282 PMCID: PMC4976158 DOI: 10.1155/2016/9480539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/30/2016] [Accepted: 06/13/2016] [Indexed: 02/07/2023]
Abstract
Background. Laparoscopic cholecystectomy is usually carried out under general anesthesia. There were a few studies which have found spinal anesthesia as a safe alternative. We aimed to evaluate the postoperative events between spinal anesthesia and general anesthesia in patients undergoing laparoscopic cholecystectomy. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to January 2016) for eligible studies. The primary outcome was the visual analogue scale score. Secondary outcomes included postoperative nausea and vomiting and urine retention 24 hours postoperatively. We calculated pooled risk ratios and 95% confidence interval using random- or fixed-effects models. Results. Eight trials involving 723 patients were listed. Meta-analysis showed that patients in spinal anesthesia groups have lower visual analogue scale score 24 hours postoperatively. There were significant decreases in the occurrence of postoperative nausea and vomiting in spinal anesthesia group when compared with general anesthesia group (odds ratios: 0.38, 95% confidence interval: 0.19-0.76; P = 0.006) with heterogeneity accepted (I (2) = 13%; P = 0.33), while urine retention rate was increased in patients with spinal anesthesia (odds ratios: 4.95, 95% confidence interval: 1.24-19.71; P = 0.02) without any heterogeneity (I (2) = 0%; P = 0.98). Conclusions. Spinal anesthesia may be associated with less postoperative pain and postoperative nausea and vomiting compared with general anesthesia.
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Affiliation(s)
- Xian-Xue Wang
- Department of Anesthesiology, The First People's Hospital of Changde City, Changde, Hunan 415003, China
| | - Quan Zhou
- Science & Education Division, The First People's Hospital of Changde City, Changde, Hunan 415003, China
| | - Dao-Bo Pan
- Department of Anesthesiology, The First People's Hospital of Changde City, Changde, Hunan 415003, China
| | - Hui-Wei Deng
- Department of Anesthesiology, The First People's Hospital of Changde City, Changde, Hunan 415003, China
| | - Ai-Guo Zhou
- Department of Anesthesiology, The First People's Hospital of Changde City, Changde, Hunan 415003, China
| | - Hua-Jing Guo
- Department of Anesthesiology, The First People's Hospital of Changde City, Changde, Hunan 415003, China
| | - Fu-Rong Huang
- Department of Anesthesiology, The First People's Hospital of Changde City, Changde, Hunan 415003, China
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Murray M, Healy DA, Ferguson J, Bashar K, McHugh S, Clarke Moloney M, Walsh SR. Effect of institutional volume on laparoscopic cholecystectomy outcomes: Systematic review and meta-analysis. World J Meta-Anal 2015; 3:26-35. [DOI: 10.13105/wjma.v3.i1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/02/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine whether institutional laparoscopy cholecystectomy (LC) volume affects rates of mortality, conversion to open surgery, bile leakage and bile duct injury (BDI).
METHODS: Eligible studies were prospective or retrospective cohort studies that provided data on outcomes from consecutive LC procedures in single institutions. Relevant outcomes were mortality, conversion to open surgery, bile leakage and BDI. We performed a Medline search and extracted data. A regression analysis using generalized estimating equations were used to determine the influence of annual institutional LC caseload on outcomes. A sensitivity analysis was performed including only those studies that were published after 1995.
RESULTS: Seventy-three cohorts (127404 LC procedures) were included. Average complication rates were 0.06% for mortality, 3.23% for conversion, 0.44% for bile leakage and 0.28% for bile duct injury. Annual institutional caseload did not influence rates of mortality (P = 0.142), bile leakage (P = 0.111) or bile duct injury (P = 0.198) although increasing caseload was associated with reduced incidence of conversion (P = 0.019). Results from the sensitivity analyses were similar.
CONCLUSION: Institutional volume is a determinant of LC complications. It is unclear whether volume is directly linked to complication rates or whether it is an index for protocolised care.
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Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: a study of 1,096 cases. J Laparoendosc Adv Surg Tech A 2013; 23:849-54. [PMID: 23980592 DOI: 10.1089/lap.2012.0561] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Low conversion rate, high safety, and good cosmetic result with less medical cost are chased by all laparoscopic surgeons. We used general laparoscopic instruments and combined with absorbable thread trying to perform a clipless minilaparoscopic cholecystectomy for benign gallbladder patients and got all the above-mentioned results. SUBJECTS AND METHODS From January 2008 to February 2011, 1096 minilaparoscopic cholecystectomies were performed for patients with uncomplicated or complicated benign gallbladder disease by our treatment team. The three-port technique with the help of an electrocautery hook, forceps, and suction was applied for laparoscopy cholecystectomy, and the cystic duct and vessels were ligated by absorbable thread rather than hemostasis clips and Harmonic(®) scalpels (Ethicon, Cincinnati, OH). The operative time, blood loss, subhepatic drain, conversion rate, drainage time, and hospital stay were reviewed and statistically analyzed. RESULTS Our conversion rate was 0.18%, which was much lower than those reported by many studies. The mean operating time was 28 minutes (range, 11-70 minutes). Mean blood loss was 12 mL (range, 5-200 mL). A subhepatic drain was placed in 63 patients, with a mean drainage time of 1.7 days (range, 1-6 days). The mean postoperative hospital stay was 2.5 days (range, 2-7 days). No postoperative bleeding, biliary leakage, intraabdominal infection, umbilical site infection, umbilical incision herniation, biliary duct or bowel injury, or mortality occurred. CONCLUSIONS Minilaparoscopic cholecystectomy using absorbable thread instead of clips and Harmonic scalpels offers a safe, effective, and economical surgical alternative for benign gallbladder patients.
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Affiliation(s)
- Guangjun Suo
- Department of Digestive Surgery, East Hospital, Tongji University School of Medicine , Shanghai, People's Republic of China
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Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study. Surg Laparosc Endosc Percutan Tech 2012; 22:226-31. [PMID: 22678318 DOI: 10.1097/sle.0b013e31824f25cd] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. METHODS The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined-patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. RESULTS Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n=30) or the knot-tying (polyglactin) suture group (n=31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P>0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27 ± 12.2 min) was shorter than that for the knot-tying group (62.81 ± 15.4 min) (P=0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P>0.05). CONCLUSIONS In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.
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Is Monopolar Electrocautery Safe and Effective for Control of the Cystic Artery During Laparoscopic Cholecystectomy? J Laparoendosc Adv Surg Tech A 2012; 22:557-60. [DOI: 10.1089/lap.2011.0507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bessa SS, Katri KM, Abdel-Salam WN, El-Kayal ESA, Tawfik TA. Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study. J Laparoendosc Adv Surg Tech A 2012; 22:550-5. [PMID: 22686181 DOI: 10.1089/lap.2012.0110] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the surgical outcome of day-case laparoscopic cholecystectomy (DCLC) performed with the patient under spinal anesthesia with that performed with the patients under general anesthesia in the management of symptomatic uncomplicated gallstone disease. PATIENTS AND METHODS One hundred eighty patients were prospectively randomized to either the spinal anesthesia DCLC group (SA-DCLC group) or the general anesthesia DCLC group (GA-DCLC group). Intraoperative events related to spinal anesthesia, postoperative complications, and pain scores were recorded. The incidences of both overnight stay and readmissions were also recorded. Patient satisfaction values as to the anesthetic technique and same-day discharge were assessed by direct questionnaire at the end of the first postoperative week. RESULTS In both groups, all procedures were completed laparoscopically. In the SA-DCLC group, there were 4 (4.4%) anesthetic conversions due to intolerable right shoulder pain, and those 4 patients were excluded from further analysis. In the SA-DCLC group, all patients were discharged on the same day. Overnight stay was required in 8 patients (8.9%) in the GA-DCLC group (P<.001). The cause of overnight stay was nausea and vomiting in 4 patients (4.4%), inadequate pain control in 3 patients (3.3%), and unexplained hypotension in 1 patient (1.1%). Readmission was required in 1 patient (1.1%) in the GA-DCLC group. The difference in patient satisfaction scores with regard to both anesthetic technique and same-day discharge was not statistically significant between the two groups studied. CONCLUSIONS DCLC performed with the patient under spinal anesthesia is feasible and safe and is associated with less postoperative pain and lower incidence of postoperative nausea and vomiting and therefore a lower incidence of overnight stay compared with that performed with the patient under general anesthesia.
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Affiliation(s)
- Samer S Bessa
- Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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Pesce A, Portale TR, Minutolo V, Scilletta R, Li Destri G, Puleo S. Bile duct injury during laparoscopic cholecystectomy without intraoperative cholangiography: a retrospective study on 1,100 selected patients. Dig Surg 2012; 29:310-4. [PMID: 22986956 DOI: 10.1159/000341660] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 07/02/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LCs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed. METHODS Data from 1,100 selected patients (728 females and 372 males) undergoing LC without the use of IOC from January 2003 to November 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during the learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Veress technique in 319 cases (29%) and the Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study. RESULTS Two CBD injuries (0.18%) and three biliary leaks (0.27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0.36%). There was no postoperative mortality. CONCLUSION LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate preoperative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures which must be taken to prevent CBD injury.
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Affiliation(s)
- Antonio Pesce
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
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Lengyel BI, Azagury D, Varban O, Panizales MT, Steinberg J, Brooks DC, Ashley SW, Tavakkolizadeh A. Laparoscopic cholecystectomy after a quarter century: why do we still convert? Surg Endosc 2011; 26:508-13. [PMID: 21938579 DOI: 10.1007/s00464-011-1909-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/06/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the gold standard procedure for gallbladder removal. However, conversion to open surgery is sometimes needed. The factors underlying a surgeon's decision to convert a laparoscopic case to an open case are complex and poorly understood. With decreasing experience in open cholecystectomy, this procedure is however no longer the "safe" alternative it once was. With such an impending paradigm shift, this study aimed to identify the main reasons for conversion and ultimately to develop guidelines to help reduce the conversion rates. METHODS Using the National Surgical Quality Improvement Program (NSQIP) database and financial records, the authors retrospectively reviewed 1,193 cholecystectomies performed at their institution from 2002 to 2009 and identified 70 conversions. Two independent surgeons reviewed the operative notes and determined the reasons for conversion. The number of ports at the time and the extent of dissection before conversion were assessed and used to create new conversion categories. Hospital length of stay (LOS), 30-day complications, operative times and charges, and hospital charges were compared between the new groups. RESULTS In 91% of conversion cases, the conversion was elective. In 49% of these conversions, the number of ports was fewer than four. According to the new conversion categories, most conversions were performed after minimal or no attempt at dissection. There were no differences in LOS, complications, operating room charges, or hospital charges between categories. Of the six emergent conversions (9%), bleeding and concern about common bile duct (CBD) injury were the main reasons. One CBD injury occurred. CONCLUSIONS In 49% of the cases, conversion was performed without a genuine attempt at laparoscopic dissection. Considering this new insight into the circumstances of conversion, the authors recommend that surgeons make a genuine effort at a laparoscopic approach, as reflected by placing four ports and trying to elevate the gallbladder before converting a case to an open approach.
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Affiliation(s)
- Balazs I Lengyel
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Blum CA, Adams DB. Who did the first laparoscopic cholecystectomy? J Minim Access Surg 2011; 7:165-8. [PMID: 22022097 PMCID: PMC3193755 DOI: 10.4103/0972-9941.83506] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/08/2010] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) has served as the igniting spark in the laparoscopic surgery explosion; however, it is unclear who created the spark. The question remains: Who did the first LC?
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Affiliation(s)
- Craig A Blum
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David B Adams
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Bessa SS, El-Sayes IA, El-Saiedi MK, Abdel-Baki NA, Abdel-Maksoud MM. Laparoscopic cholecystectomy under spinal versus general anesthesia: a prospective, randomized study. J Laparoendosc Adv Surg Tech A 2010; 20:515-20. [PMID: 20578922 DOI: 10.1089/lap.2010.0041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND For laparoscopic cholecystectomy (LC), the use of spinal anesthesia may offer several advantages over general anesthesia. The aim of this prospective, randomized study was to compare the surgical outcome of LC performed under general anesthesia to that of LC performed under spinal anesthesia. METHODS Sixty patients were randomly assigned to either the SALC (spinal anesthesia LC group, 30 patients) or GALC group (general anesthesia LC group, 30 patients). Intraoperative events related to spinal anesthesia, postoperative complications, and pain scores were recorded. Patient satisfaction as to the anesthetic technique received was assessed 2 weeks postoperatively by direct patient questionnaire. RESULTS In both groups, all procedures were completed laparoscopically. In the SALC group, all procedures were completed under spinal anesthesia and there were no anesthetic conversions. There was no statistically significant difference in the mean operative time between both groups. For the first 2 and 4 hours postoperatively, the mean pain score of the SALC group was statistically significantly lower than that of the GALC group. For the first 24 hours postoperatively, the mean number of analgesic ampoules/patient was statistically significantly lower in the SALC group. In the SALC group, 28 patients (93.3%) considered the technique "very well," compared with 30 patients (100%) in the GALC group. The difference in the overall patient satisfaction scores between both studied groups was not statistically significant. CONCLUSIONS LC performed under spinal anesthesia is feasible, safe, and is associated with significantly less early postoperative pain, compared to that performed under general anesthesia.
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Affiliation(s)
- Samer S Bessa
- Department of General Surgery, University of Alexandria, Alexandria, Egypt.
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Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT. Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech A 2008; 18:593-8. [PMID: 18721011 DOI: 10.1089/lap.2007.0227] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Ultrasonically activated devices have been used in gallbladder dissection in the laparoscopic cholecystectomy with encouraging results. The aim of this study was to compare between the safety and efficacy of the harmonic shears and the commonly used clip and cautery technique in achieving safe closure and division of the cystic duct in the laparoscopic cholecystectomy. METHODS In this prospective study, 120 patients with symptomatic gallstone disease were randomly assigned to either the harmonic scalpel laparoscopic cholecystectomy group (HS group=60 patients) where closure and division of the cystic duct was achieved solely by the harmonic shears or the clip and cautery laparoscopic cholecystectomy group (C&C group=60 patients). RESULTS Neither minor nor major bile leaks were encountered in either group. Similarly, no bile-duct injuries were encountered in the present study. The incidence of gallbladder perforation was statistically significantly higher in the C&C group, compared to the HS group (30 vs. 10%, respectively; P=0.002). The median operative time was statistically significantly shorter in the HS group than in the C&C group (32 vs. 40 minutes, respectively; P=0.000). No statistically significant difference was found in the incidence of postoperative complications between both groups. CONCLUSIONS The harmonic shears are as safe and effective as the commonly used clip and cautery technique in achieving safe closure and division of the cystic duct in the laparoscopic cholecystectomy. Further, it provides a superior alternative to the currently used high-frequency monopolar technology in terms of shorter operative time and lower incidence of gallbladder perforation.
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Affiliation(s)
- Samer S Bessa
- Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc 2008; 67:854-60. [PMID: 18355816 DOI: 10.1016/j.gie.2007.09.053] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 09/25/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although the concept of natural orifice transluminal endoscopic surgery (NOTES) as a minimally invasive surgical technique is gaining increasing popularity, patient perception toward NOTES is unclear. Because cholecystectomy is the most common laparoscopic procedure, the concept of NOTES was examined in this context. AIM To evaluate patient perception of NOTES as a potential technique for a cholecystectomy. PATIENTS Those patients with an intact gallbladder who were undergoing an EUS or an ERCP for evaluation of abdominal pain, pancreatitis, or suspected choledocholithiasis. SETTING Tertiary-referral center. DESIGN Cross-sectional survey. METHODS One hundred patients were given a questionnaire that described the technique, the complication rates, and benefits of laparoscopic cholecystectomy (LC). The concept of NOTES was then described in detail, with possible orifices being the mouth, the rectum, and the vagina. Patients were queried about their preference for a cholecystectomy technique (LC vs NOTES), choice of orifice, and the risks that they were willing to undergo for NOTES. RESULTS Of the 100 patients, 78% preferred NOTES, and 22% preferred LC. The mean age of the patients was 45 years; 36% of patients were men, 70% were white, and 83% had undergone a prior endoscopy; no significant differences were observed between the NOTES and LC groups for these characteristics. In multivariable modeling, those with age </= 50 years (odds ratio [OR] 1.3, P = .61), female sex (OR 2.1, P = .14), and prior endoscopy experience (OR 2.2, P = .19) were more likely to prefer NOTES than an LC. There was no difference in preference for NOTES between whites and nonwhites (OR 1.0, P = .98). The most common reasons for NOTES preference were lack of external pain (99%) and scarring (89%). Among the patients who preferred NOTES, for both men (23/25 [92%]) and women (43/53 [81%]), the oral route was the preferred orifice. A decreasing trend of patient preference for NOTES was observed with increased procedural complications: patient preference was 100% if complications were <3%, 97% if complications were equal to 3%, 15% if complications were 6%, and 6% if complications were 9%. LIMITATIONS A selective cohort of patients was evaluated. CONCLUSIONS Patients preferred NOTES to laparoscopy as the technique for cholecystectomy as long as the complication rates were comparable with current standards of LC. The oral orifice appeared to be the preferred approach for most patients. Given this favorable perception, further innovations in NOTES-related technology and refinements in procedural technique are justified.
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Analysis of a structured training programme in laparoscopic cholecystectomy. Langenbecks Arch Surg 2008; 393:943-8. [PMID: 18193451 DOI: 10.1007/s00423-007-0269-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 12/14/2007] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is an established treatment for almost all gallbladder diseases with bile duct injury rates similar to open cholecystectomy. These laparoscopic skills must be passed on to junior surgeons without compromising patient safety. MATERIALS AND METHODS We analysed our structured training programme over 6years (May 2000 to May 2006) by following three trainee surgeons during their training and beyond. During this period, 1,000 laparoscopic cholecystectomies were carried out with five consultant surgeons supervising and three new trainees who completed their accreditation in laparoscopic cholecystectomy. RESULTS There were 694 patients operated on by consultant surgeons (Group 1), 202 by trainee surgeons (Group 2) and 104 by newly trained surgeons (Group 3). There were no differences between the groups in terms of age and gender. However, there was a significant difference in gallbladder disease among the three groups; Group 2 had more gallstone pancreatitis patients (P < 0.019). There were no differences among the three groups in conversion rates, bile duct injury rates, general complication rates or length of stay. However, the duration of operation in Group 2 was significantly longer compared to the other two groups (P < 0.0001). CONCLUSION This programme is effective in training junior surgeons and does not compromise patient safety.
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Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol 2007; 13:5629-34. [PMID: 17948938 PMCID: PMC4172743 DOI: 10.3748/wjg.v13.i42.5629] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the anatomic variations in the cystic artery by laparoscopy, and to provide a new classification system for the guidance of laparoscopic surgeons.
METHODS: Six hundred patients treated with laparoscopic cholecystectomy from June 2005 to May 2006 were studied retrospectively. The laparoscope of 30˚ (Stryker, American) was applied. Anatomic structures of cystic artery and conditions of Calot's triangle under laparoscope were recorded respectively.
RESULTS: Laparoscopy has revealed there are many anatomic variations of the cystic artery that occur frequently. Based on our experience with 600 laparoscopic cholecystectomies, we present a new classification of anatomic variations of the cystic artery, which can be divided into three groups: (1) Calot's triangle type, found in 513 patients (85.5%); (2) outside Calot's triangle, found in 78 patients (13%); (3) compound type, observed in 9 patients (1.5%).
CONCLUSION: Our classification of the anatomic variations of the cystic artery will be useful for decreasing uncontrollable cystic artery hemorrhage, and avoiding extrahepatic bile duct injury.
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Caínzos M, Rodríguez-Segade F, Martinez-Castro J, Prieto D, Becker MR, Aneiros F, Cortes J. Intra-abdominal adhesions after open and laparoscopic cholecystectomy: an experimental model. J Laparoendosc Adv Surg Tech A 2006; 16:108-12. [PMID: 16646698 DOI: 10.1089/lap.2006.16.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the incidence of intra-abdominal adherences after open and laparoscopic cholecystectomy, on the basis of an experimental study in pigs. MATERIALS AND METHODS A total of 40 female pigs, mean weight 25 kg, underwent open cholecystectomy by right subcostal laparotomy (group A, n = 22) or laparoscopic cholecystectomy using a Storz laparoscope (group B, n = 18). After surgery, the abdominal wall was closed with polydioxanone suture and staples (group A) or with staples only (group B). One month later, the pigs underwent medial laparotomy to assess whether intra-abdominal adherences had developed. Incidences were compared between groups by the chi-square test with Yates correction. RESULTS Five pigs in group A and one pig in group B died within 24 hours of surgery, leaving 17 pigs in each group. Mean operative time was similar for both groups (24.7 minutes in group A, 25.3 minutes in group B). In group A, 16 pigs (94%) developed intra-abdominal adherences, in all cases multiple; in group B, only 9 pigs (53%) developed adherences, and in 8 of these pigs only a single adherence was present (P < 0.03). CONCLUSIONS The results of this study indicate that the incidence of intra-abdominal adherences is statistical lower after laparoscopic cholecystectomy than after open cholecystectomy.
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Affiliation(s)
- Miguel Caínzos
- General Surgery, Hospital Clínico Universitario Medical School, Santiago de Compostela, Spain.
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Barut İ, Tarhan ÖR, Çerçi C, Bülbül M. EXPERIENCE OF AMBULATORY LAPAROSCOPIC CHOLECYSTECTOMY IN TURKISH PATIENTS. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2005. [DOI: 10.29333/ejgm/82318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fuentes JM, Hanly EJ, Bachman SL, Aurora AR, Marohn MR, Talamini MA. Videoendoscopic endotracheal intubation in the rat: A comprehensive rodent model of laparoscopic surgery1,2. J Surg Res 2004; 122:240-8. [PMID: 15555624 DOI: 10.1016/j.jss.2004.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Indexed: 12/20/2022]
Abstract
BACKGROUND Peritoneal absorption of CO(2) during abdominal insufflation in laparoscopy may disrupt the acid-base equilibrium and alter the physiological response to stress. Current nonventilated rodent models of laparoscopy do not manage the CO(2) load of pneumoperitoneum, but ventilated surgical rodent models are invasive (tracheotomy) and may independently induce the inflammatory response. MATERIALS AND METHODS A comprehensive rodent model of laparoscopy was developed. Rats were randomized to receive anesthesia alone, anesthesia plus CO(2) pneumoperitoneum, or anesthesia plus CO(2) pneumoperitoneum with videoendoscopic intubation and mechanical ventilation. Arterial blood-gas analysis was performed at baseline and after 30 min of intervention. RESULTS Baseline pH, pCO(2), and HCO(3)(-) arterial blood gas parameters were normal for all rats. After 30 min, pCO(2) and pH changed slightly but remained normal among rats receiving anesthesia alone (pCO(2) = 46.5 +/- 1.9; pH = 7.365 +/- 0.009) whereas animals receiving anesthesia plus CO(2) pneumoperitoneum that were dependent on spontaneous respiration for ventilation developed significant hypercarbic acidosis (pCO(2) = 53.2 +/- 1.9, P < 0.05; pH = 7.299 +/- 0.011, P < 0.001). This acidosis was completely corrected with increased minute ventilation in intubated rats receiving mechanical ventilation (pCO(2) = 36.8 +/- 1.5, P < 0.001; pH = 7.398 +/- 0.011, P < 0.001). CONCLUSIONS CO(2) pneumoperitoneum induces significant hypercarbic acidosis in nonventilated rats. Noninvasive endotracheal intubation is feasible in the rat with videoendoscopic assistance. Our noninvasive rodent model of laparoscopic surgery controls for anesthesia- and capnoperitoneum-related acid-base changes and provides an environment in which the biological response to pneumoperitoneum can be studied precisely.
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Affiliation(s)
- Joseph M Fuentes
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
BACKGROUND Minimally invasive techniques in the surgical treatment of gallbladder disease include laparoscopic cholecystectomy (LC) and mini-cholecystectomy (MC). Reports of LC in acute or chronic inflammation of the gallbladder are common, but those of MC are much more limited, particularly in complicated cases. METHODS Thirty-six consecutive patients with gallstone disease who underwent mini-cholecystectomy (MC) were included in this study. Twenty-four were female, median age 62 years (range 23-82) and median body mass index (BMI) was 23.4 (range 17.0-28.4). Seventeen of 36 patients had an acutely inflamed gallbladder, one with septicaemia, and six had gangrenous cholecystitis. Three patients presented with acute pancreatitis. MC was performed by a standardised technique. Operative time, frequency of postoperative analgesic injections, time to start oral diet after operation and length of postoperative hospital stay were compared between patients with chronic and acute cholecystitis. RESULTS The median operative time was 92.5 minutes (range 35-130). There was no difference in operative time between patients with chronic and acute cholecystitis: 80 minutes (range 35-120) vs 95 minutes (range 60-130). The frequency of postoperative analgesic injections was also similar in the two groups. Oral diet could be started within 24 h of operation in all except one patient with chronic cholecystitis but in only 8 of 17 with acute cholecystitis. Postoperative hospital stay was shorter in patients with chronic cholecystitis: 2 days (range 2-5) vs 4 days (range 2-14), p =0.0009. CONCLUSIONS MC is an effective surgical procedure for an inflamed gallbladder regardless of the degree and type of inflammation. Patients with chronic cholecystitis recover more quickly and have a shorter hospital stay.
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Affiliation(s)
- P Watanapa
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityBangkok 10700Thailand
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