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de Paula Reis Guimarães V, Miranda J, Tamura Sttefano Guimarães C, Leão Filho H, Blasbalg R, Lahan-Martins D, Velloni FG. A comprehensive exploration of gallbladder health: from common to rare imaging findings. Abdom Radiol (NY) 2024:10.1007/s00261-024-04431-4. [PMID: 38953999 DOI: 10.1007/s00261-024-04431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
This comprehensive review explores a wide range of imaging findings associated with the gallbladder (GB), from anatomic variants to rare diseases. Through an in-depth review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography, CT, and MRI, we aim to highlight the crucial role of imaging techniques in diagnosing GB disorders, as congenital anomalies, inflammatory diseases, neoplasms, and surgical complications. Employing a detailed analysis and comparison of imaging findings across various modalities, this review seeks to improve diagnostic accuracy for GB-related pathologies, facilitating optimal patient management.
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Affiliation(s)
- Vivianne de Paula Reis Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil.
| | - Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
- Department of Radiology, University of São Paulo, R. Dr. Ovídio Pires de Campos, 75 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Cássia Tamura Sttefano Guimarães
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Hilton Leão Filho
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Roberto Blasbalg
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
| | - Daniel Lahan-Martins
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
- Department of Radiology, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), R. Tessália Vieira de Camargo, 126-Cidade Universitária, Campinas, SP, 13083-887, Brazil
| | - Fernanda Garozzo Velloni
- Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, São Paulo, SP, 06455-010, Brazil
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Kazi IA, Siddiqui MA, Thimmappa ND, Abdelaziz A, Gaballah AH, Davis R, Kimchi E, Hammoud G, Syed KA, Nasrullah A. Post-operative complications of cholecystectomy: what the radiologist needs to know. Abdom Radiol (NY) 2024:10.1007/s00261-024-04387-5. [PMID: 38940909 DOI: 10.1007/s00261-024-04387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
Cholecystectomy is one of the most performed surgical procedures. The safety of this surgery notwithstanding, the sheer volume of operations results in a notable incidence of post-cholecystectomy complications. Early and accurate diagnosis of such complications is essential for timely and effective management. Imaging techniques are critical for this purpose, aiding in distinguishing between expected postsurgical changes and true complications. This review highlights current knowledge on the indications for cholecystectomy, pertinent surgical anatomy and surgical technique, and the recognition of anatomical variants that may complicate surgery. The article also outlines the roles of various imaging modalities in identifying complications, the spectrum of possible postsurgical anatomical changes, and the implications of such findings. Furthermore, we explore the array of complications that can arise post-cholecystectomy, such as biliary system injuries, gallstone-related issues, vascular complications, and the formation of postsurgical collections. Radiologists should be adept at identifying normal and abnormal postoperative findings to guide patient management effectively.
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Affiliation(s)
- Irfan Amir Kazi
- Department of Radiology, University Hospital, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA.
| | - M Azfar Siddiqui
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Amr Abdelaziz
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Ayman H Gaballah
- Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Ryan Davis
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Eric Kimchi
- Department of Surgical Oncology, University of Missouri, Columbia, MO, USA
| | - Ghassan Hammoud
- Department of Gastroenterology, University of Missouri, Columbia, MO, USA
| | - Kazi A Syed
- Medical Student, Kansas City University College of Osteopathic Medicine, Kansas, MO, USA
| | - Ayesha Nasrullah
- Department of Radiology, University of Missouri, Columbia, MO, USA
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Hamid M, Kershaw M, Bhakthavalsalan R, Shivamurthy R, Davies S, Singhal R, Nijjar R, Wiggins T, Camprodon R, Ahmed Z. Pre-Operative Group and Save in Elective and Emergency Laparoscopic Cholecystectomy: Necessity, Cost-Effectiveness, and Own Experience. J Clin Med 2024; 13:2749. [PMID: 38792291 PMCID: PMC11122548 DOI: 10.3390/jcm13102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. Methods: A prospective multi-centre observational study was conducted to investigate patients undergoing either elective or emergency laparoscopic cholecystectomy in the UK between January 2020 and May 2021. Multivariate logistical regression models were used to identify patient factors associated with the risk of transfusion and explore outcomes linked to pre-operative G&S sampling. Results: This study comprised 959 patients, with 631 (65.8%) undergoing elective cholecystectomy and 328 (34.2%) undergoing emergency surgery. The median age was 48 years (range: 35-59), with 724 (75.5%) of the patients being female. Only five patients (0.5%) required blood transfusions, receiving an average of three units, with the first unit administered approximately six hours post-operatively. Among these cases, three patients (60%) had underlying haematological conditions. In adjusted models, male gender was significantly associated with the need for a blood transfusion (OR 11.31, p = 0.013), while the presence of a pre-operative Group and Save sample did not demonstrate any positive impact on patient outcomes. Conclusions: The incidence of blood transfusion following laparoscopic cholecystectomy is very low. Male gender and haematological conditions may present as independent risk factors. Pre-operative G&S sampling did not yield any positive impact on patient outcomes and could be safely excluded in both elective and emergency cases, although certain population subsets will warrant further consideration.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Marie Kershaw
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Resya Bhakthavalsalan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishika Shivamurthy
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sian Davies
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishi Singhal
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rajwinder Nijjar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Tom Wiggins
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Ricardo Camprodon
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Zuhair Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
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Shrestha R, Chayaput P, Wongkongkam K, Chanruangvanich W. Prevalence and predictors of postcholecystectomy syndrome in Nepalese patients after 1 week of laparoscopic cholecystectomy: a cross-sectional study. Sci Rep 2024; 14:4903. [PMID: 38418688 PMCID: PMC10902287 DOI: 10.1038/s41598-024-55625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07-19.67, p < 0.01) and moderate to severe dyspepsia (OR = 4.01, 95%CI = 1.34-12.02, p < 0.05) held the likelihood to report PCS 6.38 and 4.01 times, respectively, greater than others. The implications from study results are that screening of anxiety and patients' tailored interventions to reduce anxiety should be implemented preoperatively. An appropriate health education about persistence of PCS and self-management should be provided to those postoperative patients.
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Affiliation(s)
- Roshani Shrestha
- Master of Nursing Science Program in Adult and Gerontological Nursing, Faculty of Nursing, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand
- Department of Nursing, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal
| | - Prangtip Chayaput
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, 10700, Thailand.
| | - Kessiri Wongkongkam
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, 10700, Thailand
| | - Wallada Chanruangvanich
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, 10700, Thailand
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Kaoukabani G, Gokcal F, Fanta A, Liu X, Shields M, Stricklin C, Friedman A, Kudsi OY. A multifactorial evaluation of objective performance indicators and video analysis in the context of case complexity and clinical outcomes in robotic-assisted cholecystectomy. Surg Endosc 2023; 37:8540-8551. [PMID: 37789179 DOI: 10.1007/s00464-023-10432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The increased digitization in robotic surgical procedures today enables surgeons to quantify their movements through data captured directly from the robotic system. These calculations, called objective performance indicators (OPIs), offer unprecedented detail into surgical performance. In this study, we link case- and surgical step-specific OPIs to case complexity, surgical experience and console utilization, and post-operative clinical complications across 87 robotic cholecystectomy (RC) cases. METHODS Videos of RCs performed by a principal surgeon with and without fellows were segmented into eight surgical steps and linked to patients' clinical data. Data for OPI calculations were extracted from an Intuitive Data Recorder and the da Vinci ® robotic system. RC cases were each assigned a Nassar and Parkland Grading score and categorized as standard or complex. OPIs were compared across complexity groups, console attributions, and post-surgical complication severities to determine objective relationships across variables. RESULTS Across cases, differences in camera control and head positioning metrics of the principal surgeon were observed when comparing standard and complex cases. Further, OPI differences across the principal surgeon and the fellow(s) were observed in standard cases and include differences in arm swapping, camera control, and clutching behaviors. Monopolar coagulation energy usage differences were also observed. Select surgical step duration differences were observed across complexities and console attributions, and additional surgical task analyses determine the adhesion removal and liver bed hemostasis steps to be the most impactful steps for case complexity and post-surgical complications, respectively. CONCLUSION This is the first study to establish the association between OPIs, case complexities, and clinical complications in RC. We identified OPI differences in intra-operative behaviors and post-surgical complications dependent on surgeon expertise and case complexity, opening the door for more standardized assessments of teaching cases, surgical behaviors and case complexities.
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Affiliation(s)
| | - Fahri Gokcal
- Good Samaritan Medical Center, Brockton, MA, USA
| | - Abeselom Fanta
- Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA
| | - Xi Liu
- Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA
| | - Mallory Shields
- Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA
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Chang CH, Ding DC. Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study. J Chin Med Assoc 2023; 86:682-687. [PMID: 37185219 DOI: 10.1097/jcma.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). METHODS We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. RESULTS Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. CONCLUSION Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.
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Affiliation(s)
- Chi-Han Chang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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Pang T, Wu Z, Zeng H, Zhang X, Hu M, Cao L. Analysis of the risk factors for secondary hemorrhage after abdominal surgery. Front Surg 2023; 10:1091162. [PMID: 37346762 PMCID: PMC10279872 DOI: 10.3389/fsurg.2023.1091162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/24/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction This study aimed to conduct a clinical review and analysis to recommend options for the prevention and treatment of postoperative hemorrhage. Patients and Methods A total of 138 patients who experienced postoperative hemorrhage after abdominal surgery in the period between January 2015 and December 2020 at the Sir Run Run Shaw Hospital, affiliated to Zhejiang University School of Medicine, participated in this study. They were divided into a group with primary bleeding only and a secondary bleeding group. Univariate and multivariate statistical analyses were performed, followed by plotting of cumulative hazard and survival curves for the two groups. Results The main factors of interest found to be associated with secondary hemorrhage were duration of the operation, the time of the first bleeding incident, intervention time, performance of combined organ resection, use of surgical intervention, occurrence of abdominal infection, admission to the intensive care unit (ICU), postoperative length of stay, and total hospitalization expenses. Among these, a long operative duration (>5 h) and an extended intervention time (>5 h) were identified as independent predictors of risk of secondary hemorrhage. Conclusions Secondary hemorrhage after abdominal surgery is mainly associated with subjective human factors, and it is an important cause of poor prognosis and even death. Proper reductions in operation time and implementation of a quick response to bleeding are the key factors in tackling bleeding. Further reduction in the rates of postoperative hemorrhage and mortality will require a concerted effort by surgeons in terms of both intraoperative surgical techniques and postoperative management.
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Affiliation(s)
- Tianshu Pang
- Department of General Surgery, School of Medicine, Sir RunRun Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Zhengrong Wu
- Department of General Surgery, School of Medicine, Sir RunRun Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Hongfen Zeng
- Department of Nursing, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xiangyu Zhang
- Department of General Surgery, School of Medicine, Sir RunRun Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Mengya Hu
- Department of Nursing, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Liping Cao
- Department of General Surgery, School of Medicine, Sir RunRun Shaw Hospital, Zhejiang University, Hangzhou, China
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Maddu K, Polireddy K, Hsu D, Hoff C. Do not get stumped: multimodality imaging findings of early and late post-cholecystectomy complications. Emerg Radiol 2023; 30:351-362. [PMID: 37043146 DOI: 10.1007/s10140-023-02131-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/31/2023] [Indexed: 04/13/2023]
Abstract
Cholecystectomy is the most performed intra-abdominal surgical procedure in the US, with 1.2 million performed annually, and is predominantly performed laparoscopically. Although largely safe, laparoscopic cholecystectomy results in higher rates of abdominal symptoms consisting of abdominal pain and dyspepsia, which may persist or recur, collectively known as post-cholecystectomy syndrome. This article aims to (1) provide an overview of post-cholecystectomy syndrome with an emphasis on biliary complications and emergent imaging findings, (2) illustrate the spectrum of imaging findings of early and late post-cholecystectomy complications, (3) enumerate the role of various imaging modalities in evaluating post-cholecystectomy complications and address the role of selective trans-catheter coil embolization in managing bile leaks, and (4) discuss pearls and pitfalls in imaging following cholecystectomy. While common first-line imaging modalities for post-cholecystectomy complications include CT and sonography, ERCP and MRCP can delineate the biliary tree with greater detail. Scintigraphy has a higher sensitivity and specificity than CT or sonography for diagnosing bile leak and may preclude the need for ERCP. Post-operative complications include biliary duct injury or leak, biliary obstruction, remnant gallbladder/cystic duct stones and inflammation, biliary dyskinesia, papillary stenosis, and vascular injury. Subtle cases resulting in lethal outcomes, such as hemorrhage from the gallbladder bed without major vessel injury, have also been described. Cases presented will include biliary complications such as post-cholecystectomy stump cholecystitis, nonbiliary complications such as subcapsular hematoma, and normal post-surgical findings such as oxidized regenerated cellulose. Post-operative biliary complications can cause significant morbidity and mortality, and thus familiarity with the expected post-surgical appearance of the gallbladder fossa and biliary tract, as well as understanding the spectrum of complications and associated multimodality imaging findings, are essential for emergency radiologists and those practicing in the acute care setting to direct appropriate patient management. Furthermore, many of the postoperative complications can be managed by noninvasive percutaneous interventional procedures, from drain placement to cystic artery and cystic duct stump embolization.
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Affiliation(s)
- Kiran Maddu
- Department of Radiology, Emory University Hospital, Atlanta, GA, USA.
| | | | - Derek Hsu
- Department of Radiology, Emory University Hospital, Atlanta, GA, USA
| | - Carrie Hoff
- Department of Radiology, Emory University Hospital, Atlanta, GA, USA
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Pesce A, Fabbri N, Feo CV. Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication. World J Gastrointest Surg 2023; 15:338-345. [PMID: 37032796 PMCID: PMC10080601 DOI: 10.4240/wjgs.v15.i3.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/05/2023] [Accepted: 02/23/2023] [Indexed: 03/27/2023] Open
Abstract
Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide. Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality, especially when facing major bleeding during laparoscopy, where bleeding control can be technically challenging in inexperienced hands. Interestingly, the reported incidence rate of conversion to open surgery due to vascular lesions is approximately 0%-1.9%, with a mortality rate of approximately 0.02%. The primary aim of this article was to perform an up-to-date overview regarding the incidence and surgical management of vascular injuries during laparoscopic cholecystectomy according to the available scientific evidence.
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Affiliation(s)
- Antonio Pesce
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
| | - Nicolò Fabbri
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
| | - Carlo Vittorio Feo
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
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Marullo G, Tanzi L, Ulrich L, Porpiglia F, Vezzetti E. A Multi-Task Convolutional Neural Network for Semantic Segmentation and Event Detection in Laparoscopic Surgery. J Pers Med 2023; 13:jpm13030413. [PMID: 36983595 PMCID: PMC10054284 DOI: 10.3390/jpm13030413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
The current study presents a multi-task end-to-end deep learning model for real-time blood accumulation detection and tools semantic segmentation from a laparoscopic surgery video. Intraoperative bleeding is one of the most problematic aspects of laparoscopic surgery. It is challenging to control and limits the visibility of the surgical site. Consequently, prompt treatment is required to avoid undesirable outcomes. This system exploits a shared backbone based on the encoder of the U-Net architecture and two separate branches to classify the blood accumulation event and output the segmentation map, respectively. Our main contribution is an efficient multi-task approach that achieved satisfactory results during the test on surgical videos, although trained with only RGB images and no other additional information. The proposed multi-tasking convolutional neural network did not employ any pre- or postprocessing step. It achieved a Dice Score equal to 81.89% for the semantic segmentation task and an accuracy of 90.63% for the event detection task. The results demonstrated that the concurrent tasks were properly combined since the common backbone extracted features proved beneficial for tool segmentation and event detection. Indeed, active bleeding usually happens when one of the instruments closes or interacts with anatomical tissues, and it decreases when the aspirator begins to remove the accumulated blood. Even if different aspects of the presented methodology could be improved, this work represents a preliminary attempt toward an end-to-end multi-task deep learning model for real-time video understanding.
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Affiliation(s)
- Giorgia Marullo
- Department of Management, Production, and Design Engineering, Polytechnic University of Turin, 10129 Turin, Italy
- Correspondence:
| | - Leonardo Tanzi
- Department of Management, Production, and Design Engineering, Polytechnic University of Turin, 10129 Turin, Italy
| | - Luca Ulrich
- Department of Management, Production, and Design Engineering, Polytechnic University of Turin, 10129 Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, 10124 Turin, Italy
| | - Enrico Vezzetti
- Department of Management, Production, and Design Engineering, Polytechnic University of Turin, 10129 Turin, Italy
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Educational Scoring System in Laparoscopic Cholecystectomy: Is It the Right Time to Standardize? Medicina (B Aires) 2023; 59:medicina59030446. [PMID: 36984446 PMCID: PMC10051458 DOI: 10.3390/medicina59030446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
Background and Objectives: Laparoscopic cholecystectomy (LC) is one of the most performed surgeries worldwide. Procedure difficulty and patient outcomes depend on several factors which are not considered in the current literature, including the learning curve, generating confusing and subjective results. This study aims to create a scoring system to calculate the learning curve of LC based on hepatobiliopancreatic (HPB) experts’ opinions during an educational course. Materials and Methods: A questionnaire was submitted to the panel of experts attending the HPB course at Research Institute against Digestive Cancer-IRCAD (Strasbourg, France) from 27–29 October 2022. Experts scored the proposed variables according to their degree of importance in the learning curve using a Likert scale from 1 (not useful) to 5 (very useful). Variables were included in the composite scoring system only if more than 75% of experts ranked its relevance in the learning curve assessment ≥4. A positive or negative value was assigned to each variable based on its effect on the learning curve. Results: Fifteen experts from six different countries attended the IRCAD HPB course and filled out the questionnaire. Ten variables were finally included in the learning curve scoring system (i.e., patient body weight/BMI, patient previous open surgery, emergency setting, increased inflammatory levels, presence of anatomical bile duct variation(s), and appropriate critical view of safety (CVS) identification), which were all assigned positive values. Minor or major intraoperative injuries to the biliary tract, development of postoperative complications related to biliary injuries, and mortality were assigned negative values. Conclusions: This is the first scoring system on the learning curve of LC based on variables selected through the experts’ opinions. Although the score needs to be validated through future studies, it could be a useful tool to assess its efficacy within educational programs and surgical courses.
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Ahmed SH, Usmani SUR, Mushtaq R, Samad S, Abid M, Moeed A, Atif AR, Farhan SA, Saif A. Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis. Am J Surg 2023; 225:975-987. [PMID: 36693774 DOI: 10.1016/j.amjsurg.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC). METHODS Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs. RESULTS There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG. CONCLUSION Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan.
| | - Shajie Ur Rehman Usmani
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Rabeea Mushtaq
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Saba Samad
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Minaam Abid
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Moeed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Raafe Atif
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Syed Ali Farhan
- Department of Surgery, Virginia Commonwealth University Health, 1200 E Marshall St, Richmond, VA, 23219, United States
| | - Areeba Saif
- Department of Surgery, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States
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The gallbladder: what's new in 2022? ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:2-28. [PMID: 35348807 DOI: 10.1007/s00261-022-03429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
This review focuses mainly on the imaging diagnosis, treatment, and complications of acute cholecystitis which is the most common benign disease of the gallbladder. The American College of Radiology appropriateness criteria for the imaging evaluation of patients with right upper quadrant pain and the Tokyo Guidelines for evaluating patients with acute cholecystitis and acute cholangitis are presented. The recent articles for using US, CT, MR, and HIDA in the evaluation of patients with suspected acute cholecystitis are reviewed in detail. The clinical management and postoperative complications are described. Because gallbladder polyps and adenomyomatosis can mimic gallbladder malignancies and acute cholecystitis, their imaging findings and management are presented. Finally, due the recent literature reporting better results with CT than US in the diagnosis of acute cholecystitis, a suggested approach for imaging patients with right upper quadrant pain and possible acute cholecystitis is presented in an addendum.
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Zarbaliyev E, Sevmiş M, Sarsenov D, Çelik S, Çağlıkülekçi M. When Should I Use an Additional Port at the Time of Three-Port Laparoscopic Cholecystectomy? J Laparoendosc Adv Surg Tech A 2021; 32:668-674. [PMID: 34609925 DOI: 10.1089/lap.2021.0523] [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] [Indexed: 11/13/2022] Open
Abstract
Objective: Today, it is recommended that the laparoscopic cholecystectomy (LC) is made with standard three ports. In this study, we aimed to determine the preoperative and intraoperative factors that require the use of an additional fourth port during three-port LC. Materials and Methods: All patients who started LC with three ports between January 1, 2018 and December 31, 2019 were included in the study. The patients were divided into two groups as those who underwent three-port LC and those who required additional ports. Independent parameters affecting the transition from three ports to four ports were analyzed using logistic regression analysis. The patients who underwent LC with three ports were included in Group 1 and the patients requiring an additional port were included in Group 2. Results: A total of 234 patients (139 women and 95 men) were included in the study. The average age of patients was 52.95 ± 16.26 (20-89) and body mass index is 28.64 ± 5.4 (15.73-48.89), respectively. Three ports were used in 148 patients (Group 1), and an additional fourth port was used in 42 patients (Group 2). Female gender, history of upper laparotomy, presence of acute infection findings, urgent surgery, and advanced age were observed to increase the use of additional ports. In multivariate analysis, it was shown that the presence of hepatic barrier (P < .001) and the presence of complete adhesion in the gallbladder (P < .001) significantly increased the use of additional trocars during LC. In addition, female gender was found to cause an increase of 6.62 times (P < .001). Conclusion: Many factors may require the use of additional ports during three-port LC. The use of an additional fourth port should not be avoided, especially in cases where hilum dissection is prevented due to liver origin, in female patients and in cases with complete adhesion to the gallbladder.
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Affiliation(s)
- Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Murat Sevmiş
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
| | - Dauren Sarsenov
- Department of General Surgery, Nazif Bağrıaçık Kadıköy Hospital, İstanbul, Turkey
| | - Sebahattain Çelik
- Department of General Surgery, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Mehmet Çağlıkülekçi
- Department of General Surgery, Gaziosmanpaşa Hospital, Yeni Yüzyil University, İstanbul, Turkey
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Abstract
Laparoscopic cholecystectomy is now considered the procedure of choice for uncomplicated symptomatic gallstone disease worldwide. Various biliary, vascular, gastrointestinal, neurological and local complications may be seen on imaging post surgery. Knowledge of these entities and imaging appearances is indispensable for the radiologist in today's era. We emphasize on the list of potential complications and imaging appearances of this surgical procedure.
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Affiliation(s)
- Binit Sureka
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Radiology/Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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Sgaramella LI, Gurrado A, Pasculli A, de Angelis N, Memeo R, Prete FP, Berti S, Ceccarelli G, Rigamonti M, Badessi FGA, Solari N, Milone M, Catena F, Scabini S, Vittore F, Perrone G, de Werra C, Cafiero F, Testini M. The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study. Surg Endosc 2021; 35:3698-3708. [PMID: 32780231 PMCID: PMC8195809 DOI: 10.1007/s00464-020-07852-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. METHODS Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. RESULTS Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. CONCLUSIONS The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.
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Affiliation(s)
- Lucia Ilaria Sgaramella
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Angela Gurrado
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Alessandro Pasculli
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Nicola de Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Bari, Italy
| | - Francesco Paolo Prete
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Stefano Berti
- Department of General Surgery, “Sant’Andrea” Hospital La Spezia, La Spezia, Italy
| | - Graziano Ceccarelli
- Division of General Surgery, Department of Surgery, San Donato Hospital, via Pietro Nenni 20-22, 52100 Arezzo, Italy
| | | | | | - Nicola Solari
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II” University, Napoli, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - Stefano Scabini
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Vittore
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Gennaro Perrone
- Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy
| | - Carlo de Werra
- Department of Clinical Medicine and Surgery, Federico II” University, Napoli, Italy
| | - Ferdinando Cafiero
- Department of Surgery, IRCSS Ospedale Policlinico San Martino, Genova, Italy
| | - Mario Testini
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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Romano L, Lazzarin G, Varrassi M, Di Sibio A, Vicentini V, Schietroma M, Carlei F, Giuliani A. Haemobilia secondary to a cystic artery pseudoaneurysm as complication of VLC. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021125. [PMID: 33944818 PMCID: PMC8142751 DOI: 10.23750/abm.v92is1.10821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The laparoscopic approach has become the gold standard for cholecystectomy. However, it could have some major complications. Among them, it can be considered postoperative pseudoaneurysms of the cystic or hepatic arteries. Haemobilia secondary to a cystic artery pseudoaneurysm is extremely rare. CASE REPORT Here we present a case from our centre of haemobilia in association with a cystic artery pseudoaneurysm, as a late complication of VLC. An 18-year-old girl underwent laparoscopic cholecystectomy; during surgery, due to viscero-perietal tight adhesions and due to the close proximity of the cystic duct to the biliary ducts, we suspected a bile duct injury. So, decision was taken to convert to open surgery: a suture was performed to repair the coledocic duct injury and an endoscopic papillotomy was performed with subsequent positioning of an endoscopic plastic biliary endoprothesis at the hepatocholedochus. One month after surgery, the patient showed clinical signs of hypovolemic shock. She underwent Computed Tomography Angiography, showing a possible arterial lesion, just adjacent to surgical clip. Therefore, patient underwent angiographic examination, which confirmed an 8 mm pseudoaneurysm arising from cystic artery, just adjacent to surgical clips. Superselective catheterization of vessel was performed, and two coils were released, until obtaining complete exclusion of the vascular lesion. The patient was discharged five days after procedure, with good general condition. CONCLUSION Pseudoaneurysms of the cystic artery are uncommon entities, rarely reported in the literature, and often caused by cholecystitis or iatrogenic biliary injury. All conditions that are responsible for vessels' injuries could also cause haemobilia. Even if pseudoaneurysm of cystic artery with haemobilia is a rare event, it has to be considered as a complication of VLC. Angiographic approach should be the treatment of choice.
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Affiliation(s)
- Lucia Romano
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
| | - Gianni Lazzarin
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
| | - Marco Varrassi
- Department of Radiology, S. Salvatore Hospital, L'Aquila.
| | | | - Vincenzo Vicentini
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
| | - Mario Schietroma
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
| | - Francesco Carlei
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
| | - Antonio Giuliani
- Department of Surgery, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila.
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Li L, Li Q, Xie M, Zuo W, Song B. Anatomic Variation of the Cystic Artery: New Findings and Potential Implications. J INVEST SURG 2021; 34:276-283. [PMID: 31238741 DOI: 10.1080/08941939.2019.1631917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: To determine the anatomy of the cystic artery by dual-source CT, and correlate imaging findings with those patients who had laparoscopic cholecystectomy (LC). Materials and Methods: Following institutional review board approval, a total of 289 consecutive patients (204 men and 85 women) were evaluated with CT for abdominal pain, including 55 patients subsequently underwent LC. Location of the cystic artery termination, distance between the cystic artery origin and the gallbladder, and angle between the cystic artery and its parent artery were evaluated by two radiologists. The laparoscopic surgical video record (gold standard) was similarly evaluated by a surgeon. Results: A total of 256 cystic arteries in the 247 patients were included. Cystic artery terminations are predominately found in ventral Calot triangle plane (50.8%, type II). Cystic artery origin immediately adjacent to the gallbladder surface was seen in 11/256 (4.3%). Zero angle between the cystic artery and its parent artery was found in 17 of 256 cystic arteries (6.6%). The cystic arteries and the Calot triangle were depicted in 49 patients (95% confidence interval: 85%, 97%). For all 49 patients, CT imaging findings were consistent with surgical video records. No case involved vascular and biliary injury occurred. Conclusions: Given the large number of LC performed each year, better knowledge of anatomic variation of the cystic artery could potentially prevent arterial injury and bile duct injury, particularly for patients with unusual anatomy.
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Affiliation(s)
- Li Li
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Qiang Li
- College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Wenwei Zuo
- Department of General Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Hui CL, Loo ZY. Vascular disorders of the gallbladder and bile ducts: Imaging findings. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:825-836. [PMID: 33639040 DOI: 10.1002/jhbp.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/30/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
Vascular disorders of the gallbladder and biliary tree are many and varied. In the acute setting, the clinical presentation of vascular conditions such as hemorrhagic cholecystitis and gangrenous cholecystitis are non-specific and rely on imaging for diagnosis and triaging for emergent surgery. These hemorrhagic and ischemic complications of acute cholecystitis are uncommon but potentially fatal. Hemorrhage into the gallbladder and biliary tree, from other causes, may itself result in acute cholecystitis. Knowledge of vascular anatomy of the gallbladder and biliary tree is essential for surgeons to prevent significant operative bleeding complications, particularly in laparoscopic cholecystectomy. The unique venous drainage of the gallbladder and biliary tree, with their connections to the portal venous system, lends itself to less well-recognised vascular phenomena such as gallbladder varices, portal biliopathy, and gallbladder bed perfusion abnormalities.
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20
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Enhanced Laparoscopic Vision Improves Detection of Intraoperative Adverse Events During Laparoscopy. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Lingala S, Tian M, Urayama S. An Elusive Cause of Recurrent Obstructive Jaundice Post-ERCP and Cholecystectomy. Am J Med Sci 2020; 361:398-399. [PMID: 33012485 DOI: 10.1016/j.amjms.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Shilpa Lingala
- Department of Internal Medicine, Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, California.
| | - Miao Tian
- Department of Pathology, University of California Davis Medical Center, Sacramento, California
| | - Shiro Urayama
- Department of Internal Medicine, Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, California
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22
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Management for Hemorrhage from the Gallbladder Bed Caused by Injury to the Middle Hepatic Vein During Laparoscopic Cholecystectomy. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01925-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Santivañez JJ, Velásquez ME, Cadena M, Vergara A. Management of Middle Hepatic Vein Injury during Laparoscopic Cholecystectomy: A Case Report. Surg J (N Y) 2020; 6:e47-e48. [PMID: 32158952 PMCID: PMC7062551 DOI: 10.1055/s-0040-1701695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background
Cholecystectomy continues to be the first choice for the treatment of symptomatic cholelithiasis. Especially in patients with acute cholecystitis, a laparoscopic approach has become the standard treatment option. Intraoperative complications of laparoscopic cholecystectomy include: bile duct injury, organ damage, and bleeding due to vascular injury. Difficult hemorrhage during laparoscopic cholecystectomy occurs in 0.1 to 1.9% of all cases. Besides major vessel injuries, gallbladder bed vasculature is reported as a common injury site, mostly secondary to middle hepatic vein lesions.
Case Presentation
We present a case report of a patient taken for a laparoscopic cholecystectomy. During the procedure, inadvertent middle hepatic vein injury occurs. Here we describe the management approach selected for this type of injury.
Discussion
We recommend careful dissection during the final steps of a laparoscopic cholecystectomy. Following cystic duct and cystic artery ligation, surgeons often inappropriately relax through the last part of the dissection. During this final dissection, if care is not taken, small vascular structures can be missed and injured.
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Affiliation(s)
- Juan Jose Santivañez
- Department of General Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Department of General Surgery, Universidad El Rosario, Bogotá, Colombia
| | - María Elena Velásquez
- Department of General Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Manuel Cadena
- Department of Metabolic Support and Surgery for Intestinal Failure, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Arturo Vergara
- Department of Metabolic Support and Surgery for Intestinal Failure, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
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Fletcher E, Seabold E, Herzing K, Markert R, Gans A, Ekeh AP. Laparoscopic cholecystectomy in the Acute Care Surgery model: risk factors for complications. Trauma Surg Acute Care Open 2019; 4:e000312. [PMID: 31565675 PMCID: PMC6744070 DOI: 10.1136/tsaco-2019-000312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/01/2019] [Accepted: 07/06/2019] [Indexed: 02/05/2023] Open
Abstract
Background The Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting. Methods All patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher’s exact test, χ2 test, and Mann-Whitney U Test. Results During the study period, 547 patients (70.2% female, mean age 46.1±18.1, mean body mass index 32.4±7.8 kg/m2) had LC performed for various acute indications. Mean surgery time was 77.9±50.2 minutes, and 5.7% of cases were performed “after hours.” Rate of conversion to open procedure was 6%. Complications seen included minor bile leaks (3.8%), infection (3.8%), retained gallstones (1.1%), organ injury (1.1%), major duct injury (0.9%), and postoperative bleeding (0.9%). Statistical analysis demonstrated significant relationships between conversion, length of surgery, age, gender, and intraoperative cholangiogram with various complications. No significant relationships were detected between complications and BMI, pregnancy, attending experience, and time of operation. Discussion Although several statistically significant relationships were identified between several risk factors and complications, these findings have limited clinical significance. Factors including attending years in practice and time of the operation were not associated with increased complications. ACS services are capable of performing a high volume of LCs for emergent indications with low complication and conversion rates. Level of evidence:IV
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Affiliation(s)
- Emily Fletcher
- Department of Surgery, Wright State Physicians, Dayton, Ohio, USA
| | - Erica Seabold
- Department of Surgery, Wright State Physicians, Dayton, Ohio, USA
| | - Karen Herzing
- Department of Surgery, Wright State Physicians, Dayton, Ohio, USA
| | - Ronald Markert
- Department of Surgery, Wright State Physicians, Dayton, Ohio, USA
| | - Alyssa Gans
- Department of Surgery, Wright State Physicians, Dayton, Ohio, USA
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de Siqueira Corradi MB, D Ávila R, Duim E, Rodrigues CIS. Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital. Am J Surg 2019; 219:645-650. [PMID: 31130212 DOI: 10.1016/j.amjsurg.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholelithiasis is the most common disease of the biliary tract. We aimed to associate complications resulting from laparoscopic cholecystectomy with patients' sociodemographic and clinical data, stratifying risk based on this association. METHODS We retrospectively reviewed the medical records of 2520 patients undergoing laparoscopic cholecystectomy from January 2013 to March 2017 at our institution. Sociodemographic, clinical, and surgical complication data were collected. Unadjusted and adjusted logistic regression models were used to determine independent factors associated with the outcomes of interest. Based on the results, we proposed a risk stratification model, a treatment flowchart, and a severity score. RESULTS Mean age was 48.9 years; 83.53% were female. Intraoperative complications occurred in 206 (8.17%) patients, and postoperative complications in 54 (2.14%). Male sex, older age, diabetes, multiple previous operations, and urgent surgery (odds ratio = 23.77) were significantly associated with surgical complications in both unadjusted and adjusted models. CONCLUSIONS We could propose a flowchart based on our risk stratification model and develop a severity score based on the association between complications of laparoscopic cholecystectomy and sociodemographic/clinical data.
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Affiliation(s)
| | - Ronaldo D Ávila
- Department of Medicine, Nephrology Division, School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo (PUC-SP), R. Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
| | - Etienne Duim
- School of Public Health, Universidade de São Paulo (USP), Faculty of Health, Medicine and Life Sciences, Av. Dr Arnaldo, 715, 01246-904, São Paulo, SP, Brazil.
| | - Cibele Isaac Saad Rodrigues
- Department of Medicine, Nephrology Division and Education in Health Professions Master Program, School of Medical and Health Sciences, PUC-SP. R, Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
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Ekici U, Yılmaz S, Tatlı F. Comparative Analysis of Laparoscopic Cholecystectomy Performed in the Elderly and Younger Patients: Should We Abstain from Laparoscopic Cholecystectomy in the Elderly? Cureus 2018; 10:e2888. [PMID: 30159214 PMCID: PMC6110625 DOI: 10.7759/cureus.2888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The elderly population is gradually increasing due to an increase in the quality of life and therefore the frequency of gallbladder stones in the population is also increasing. However, a considerable number of physicians tend to postpone or solve the problem with medical treatment instead of performing surgery in the elderly patients. In this study, we aim to compare the outcomes of laparoscopic cholecystectomy (LC) in the elderly and younger patients. MATERIAL AND METHODS The medical records of 665 patients undergoing LC were evaluated retrospectively. The patients were divided into two groups: ≥60 years of age and <60 years of age. Ages, genders, comorbid diseases, indications of surgery, American Society of Anesthesiologists scores, whether it is converted to an open cholecystectomy or not, reasons for conversion if it is converted, total duration of surgery, initiation of oral nutrition, duration of discharge, and postoperative complications of the patients in both groups were recorded. RESULTS The American Society of Anesthesiologists scores were statistically significantly higher in ≥60 years age group (p<0.001). The rate of experiencing acute cholecystitis with a stone in the gallbladder was significantly higher in the 60 years group (p=0.025). Comorbidity was statistically significantly higher in the ≥60 years age group (p<0.001). Hospitalization period, the mean hour of initiation of oral nutrition were statistically significantly higher in the ≥60 years age group (p<0.001, p=0.001). Conversion to an open cholecystectomy and postoperative complication rates of the ≥60 years age group were statistically significantly higher (p=0.034, p<0.001). CONCLUSION We think that LC can be safely performed in the elderly people as well. However, it should be kept in mind that comorbidity may make the surgery and postoperative follow-up period complicated.
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Affiliation(s)
- Ugur Ekici
- Health Science and Administratioon, İstanbul Gelisim University, İstanbul, TUR
| | - Serhan Yılmaz
- General Surgery, Bakirkoy Sadi Konuk Education and Research Hospital, İstanbul, TUR
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Masci E, Faillace G, Longoni M. Use of oxidized regenerated cellulose to achieve hemostasis during laparoscopic cholecystectomy: a retrospective cohort analysis. BMC Res Notes 2018; 11:239. [PMID: 29642951 PMCID: PMC5896066 DOI: 10.1186/s13104-018-3344-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/30/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Laparoscopic cholecystectomy is the first-choice treatment for symptomatic cholelithiasis. Though generally safe, this procedure is not without complications, with bleeding the most frequent cause of conversion to open cholecystectomy. Oxidized regenerated cellulose (ORC) added to conventional hemostatic strategies, is widely used to control bleeding during surgery despite limited evidence supporting its use. This retrospective study analyzed patients undergoing laparoscopic cholecystectomy in an Italian center over a 16-month period, between October 2014 and February 2016, who experienced uncontrollable bleeding despite the use of conventional hemostatic strategies, requiring the addition of ORC gauze (Emosist®). RESULTS Of the 530 patients who underwent laparoscopic cholecystectomy, 24 (4.5%) had uncontrollable bleeding from the liver bed. Of these, 62.5% had acute cholecystitis and 33.3% chronic cholecystitis; 1 patient was diagnosed with gallbladder carcinoma, postoperatively. Most patients had comorbidities, 16.7% had liver cirrhosis, and 37.5% used oral anticoagulants. The application of ORC rapidly controlled bleeding in all patients. Patients were discharged after a mean duration of 2.2 days. ORC was easy to use and well tolerated. Bleeding complications remain a relevant issue in laparoscopic cholecystectomy. ORC was able to promptly stop bleeding not adequately controlled by conventional methods and appears, therefore, to be a useful hemostat.
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Affiliation(s)
- Emilia Masci
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
| | - Giuseppe Faillace
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
| | - Mauro Longoni
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
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Colozzi S, Iesari S, Cianca G, Lai Q, Bonanni L, Pisani F, Amicucci G. End-stage renal disease is a risk factor for complex laparoscopic cholecystectomy in patients waiting for renal transplantation. J Minim Access Surg 2018; 15:137-141. [PMID: 29483371 PMCID: PMC6438063 DOI: 10.4103/jmas.jmas_145_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: To date, there are no studies investigating whether laparoscopic cholecystectomy (LC) is technically more complex in patients waiting for kidney transplant. The aim of this study is to create a user-friendly score to identify high-risk cases for complex LC integrating end-stage renal disease (ESRD). Materials and Methods: We retrospectively analysed 321 patients undergoing LC during the period 2014–2016. Two groups were compared: ESRD group (n = 25) versus control group (n = 296). Concerning statistical analysis, continuous variables were compared using Kruskal–Wallis’ test, dummy variables with Chi-square test or Fisher's exact test when appropriate. A multivariable logistic regression analysis was performed to identify risk factors for complex LC. A backward conditional method was used to design the final model. Results: Seventy out of 321 (21.8%) cases were considered as complex, with a higher prevalence in the ESRD group (32.0 vs. 20.9%; P = 0.2). Using a multivariable logistic regression analysis, we formulated a score based on the independent risk factors for complex LC: 4×(previous cholecystitis) +5 × (previous ESRD) +1 × (age per decade) +2 × (previous open abdominal surgery). High-risk cases (score ≥ 10) were more commonly reported in the ESRD group (72.0 vs. 24.7%; P < 0.0001). Conclusion: Although several scores investigating the risk for complex LC have been proposed, none of them has focused on ESRD. This is the first series demonstrating that ESRD is an independent risk factor for technical complexity in LC. We developed a score to offer surgeons an extra tool for pre-operative evaluation of patients requiring LC.
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Affiliation(s)
- Sara Colozzi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Samuele Iesari
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Cianca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Quirino Lai
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Bonanni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Pisani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Yakura T, Hayashi S, Terayama H, Miyaki T, Nakano T, Naito M. A case of a cystic artery arising from the superior mesenteric artery with abnormal branching of the celiac trunk. BMC Res Notes 2017; 10:526. [PMID: 29084586 PMCID: PMC5661926 DOI: 10.1186/s13104-017-2858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
Objective The celiac trunk normally has three branches; i.e. the left gastric, splenic, and common hepatic artery. It is known that the right hepatic artery occasionally branches from the superior mesenteric artery, while the cystic artery arising from the superior mesenteric artery is extremely rare. A deeper understanding of cystic arterial variations is necessary for all physicians performing examinations and surgical procedures of the hepatobiliary system. Results The cystic artery arising from the superior mesenteric artery was found in the cadaver of an 86-year-old woman during an anatomy dissection class at Aichi Medical University in 2015. In this case, the cystic artery ran along the dorsal side of the portal vein through Calot’s triangle to the gallbladder. The celiac trunk had four abnormal branches, one each to the left gastric, right hepatic, splenic, and left hepatic artery. The middle colic artery was absent and the left colic artery branching from the inferior mesenteric artery was distributed along the whole length of the transverse colon. In all cases of the cystic artery arising from the superior mesenteric artery, the vessel ran along the dorsal side of the portal vein; in addition, the right hepatic artery arose from the superior mesenteric artery.
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Affiliation(s)
- Tomiko Yakura
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Shogo Hayashi
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Hayato Terayama
- Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takayoshi Miyaki
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Troncoso-Bacelis A, Soto-Amaro J, Ramírez-Velázquez C. Calentamiento en endotrainer previo a colecistectomía laparoscópica. CIR CIR 2017; 85:299-305. [DOI: 10.1016/j.circir.2016.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 10/14/2016] [Indexed: 01/11/2023]
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Garcia-Martinez A, Vicente-Samper JM, Sabater-Navarro JM. Automatic detection of surgical haemorrhage using computer vision. Artif Intell Med 2017; 78:55-60. [PMID: 28764873 DOI: 10.1016/j.artmed.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/02/2017] [Accepted: 06/05/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES On occasions, a surgical intervention can be associated with serious, potentially life-threatening complications. One of these complications is a haemorrhage during the operation, an unsolved issue that could delay the intervention or even cause the patient's death. On laparoscopic surgery this complication is even more dangerous, due to the limited vision and mobility imposed by the minimally invasive techniques. METHODS In this paper it is described a computer vision algorithm designed to analyse the images captured by a laparoscopic camera, classifying the pixels of each frame in blood pixels and background pixels and finally detecting a massive haemorrhage. The pixel classification is carried out by comparing the parameter B/R and G/R of the RGB space colour of each pixel with a threshold obtained using the global average of the whole frame of these parameters. The detection of and starting haemorrhage is achieved by analysing the variation of the previous parameters and the amount of pixel blood classified. RESULTS When classifying in vitro images, the proposed algorithm obtains accuracy over 96%, but during the analysis of an in vivo images obtained from real operations, the results worsen slightly due to poor illumination, visual interferences or sudden moves of the camera, obtaining accuracy over 88%. The detection of haemorrhages directly depends of the correct classification of blood pixels, so the analysis achieves an accuracy of 78%. CONCLUSIONS The proposed algorithm turns out to be a good starting point for an automatic detection of blood and bleeding in the surgical environment which can be applied to enhance the surgeon vision, for example showing the last frame previous to a massive haemorrhage where the incision could be seen using augmented reality capabilities.
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Affiliation(s)
- Alvaro Garcia-Martinez
- Systems and Automatics Engineering Department, Miguel Hernández University, Avinguda de la Universitat d'Elx, Elche, 03202, Spain.
| | - Jose María Vicente-Samper
- Systems and Automatics Engineering Department, Miguel Hernández University, Avinguda de la Universitat d'Elx, Elche, 03202, Spain
| | - José María Sabater-Navarro
- Systems and Automatics Engineering Department, Miguel Hernández University, Avinguda de la Universitat d'Elx, Elche, 03202, Spain
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Crozier J, Williams A, Chan STF, Thompson G. Randomized trial of laparoscopic cholecystectomy procedure-specific consent form. ANZ J Surg 2017; 88:E55-E59. [DOI: 10.1111/ans.13888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jack Crozier
- Department of Surgery; Western Health; Footscray Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Ann Williams
- Department of Surgery; Western Health; Footscray Victoria Australia
| | - Steven T. F. Chan
- Department of Surgery; Western Health; Footscray Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Graeme Thompson
- Department of Surgery; Western Health; Footscray Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
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Radunovic M, Lazovic R, Popovic N, Magdelinic M, Bulajic M, Radunovic L, Vukovic M, Radunovic M. Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis. Open Access Maced J Med Sci 2016; 4:641-646. [PMID: 28028405 PMCID: PMC5175513 DOI: 10.3889/oamjms.2016.128] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/08/2016] [Accepted: 11/05/2016] [Indexed: 01/10/2023] Open
Abstract
AIM: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions. MATERIAL AND METHODS: Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed. RESULTS: There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001). CONCLUSION: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.
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Affiliation(s)
- Miodrag Radunovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Ranko Lazovic
- Center for General and Digestive Surgery, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | | | - Milutin Bulajic
- Clinic for Gastroenterology, Clinical Centre of Belgrade, University of Belgrade, Belgrade, Serbia
| | - Lenka Radunovic
- General Medical Health, Primary Health Care Berane, Berane, Montenegro
| | - Marko Vukovic
- Urology and Nephrology Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro
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Ciftci A, Yazicioglu MB, Tiryaki C, Turgut HT, Subasi O, Ilgoz M, Civil O, Yildiz SY. Is the fourth port routinely required for laparoscopic cholecystectomy? Our three-port laparoscopic cholecystectomy experience. Ir J Med Sci 2016; 185:909-912. [PMID: 27582090 DOI: 10.1007/s11845-016-1493-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/22/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND There have been many changes in number and place of trocars that have been described, since the first laparoscopic cholecystectomy (LC), but, in fact, all authors agree that laparoscopic procedure is accepted as gold standard. However, four trocars use in standard laparoscopic cholecystectomy, it has been argued that the fourth port is not necessary for grasping fundus of gallbladder so as to expose Calot's triangle. The aim of this study is to establish the safety of three-trocar LC in symptomatic gallbladder disease and also to determine the ratio of technical requirements of the fourth trocar. METHODS Between August 2010 and January 2016, 291 cases were operated in Kocaeli Derince Education and Research Hospital, department of general surgery for symptomatic gallbladder disease with three-port LC, and their records were examined retrospectively. RESULTS Two hundred and twenty patients were female (75.6 %) and seventy one (24.4 %) were male. Two hundred and eighteen of two hundred and ninety-one cases (74.92 %) were operated with three- port LC in a secure way. In seventy-three cases (25.08 %), one more port was needed to use. Mean operative time was 33.76 ± 11:18 min. (15-90 min). In these cases, major complications, such as main bile duct injury or bile leakage, that may increase the mortality and morbidity, did not occur. Only in one case (0.34 %) postoperative bleeding was seen from the liver bed, which was required exploration. CONCLUSION We concluded that in experienced hand, LC with three ports is safe and feasible technique if it is not endanger the course of the surgery.
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Affiliation(s)
- A Ciftci
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
| | - M B Yazicioglu
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - C Tiryaki
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - H T Turgut
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - O Subasi
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - M Ilgoz
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - O Civil
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - S Y Yildiz
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Abstract
Outpatient thyroid surgery is controversial because of concerns over life-threatening cervical hematoma. Despite this concern, outpatient thyroidectomy is becoming increasingly common, especially among high-volume endocrine surgeons. Multiple studies have now demonstrated that careful patient selection combined with surgeon experience can result in successful and safe surgery without a full inpatient admission. This article reviews the data on safety and outcomes for outpatient thyroidectomy and discusses several techniques used to minimize risk to patients.
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Affiliation(s)
- Courtney J Balentine
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, K3/704 Clinical Science Center, Madison, WI 53792-7375, USA
| | - Rebecca S Sippel
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, K3/704 Clinical Science Center, Madison, WI 53792-7375, USA.
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Hosseini SV, Solhjou Z, Pourahmad S, Rahimikazerooni S, Gabash KM, Bagherpourjahromi A, Rezaianzadeh A, Bahrami F. The early outcome of single-incision versus multi-port laparoscopic cholecystectomy. Adv Biomed Res 2015; 4:161. [PMID: 26430654 PMCID: PMC4581098 DOI: 10.4103/2277-9175.162530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 01/13/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Single-incision laparoscopic cholecystectomy (SILC) is a newly developed method of performing cholecystectomy and has been increasingly used. The aim of this study is to see if SILC has any advantages over conventional (three-port) laparoscopic cholecystectomy (CLC). Materials and Methods: In this cross-sectional study, 52 patients who underwent SILC (group A) during the period from May 2011 to March 2013 were compared with 62 patients who underwent CLC (group B) at two centers affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. Data were gathered on operation time, pre- and postoperative complications, patients’ postoperative pain, pain reliever use, duration of hospital stay, and return to work, and these data were compared using SPSS software version 16. Results: The mean age of patients was 38.01 ± 13.24 in group A and 44.82 ± 15.11 in group B. Mean body mass index (BMI) was 23.97 ± 4.78 and 26.22 ± 4.67 in groups A and B, respectively. The mean operation time was 76.4 ± 29.0 min in group A and 72.9 ± 24.1 min in group B (P = 0.496). Preoperative complications were 3.8% in group A and 0 in group B (P = 0.206). Postoperative complications were 17.3% in group A and 11.3% in group B (P = 0.423). The mean for early postoperative pain revealed no significant difference (P = 0.814), but the mean pain on discharge was significantly higher in group A patients (P = 0.034). Regarding the mean admission time and return to normal activity, we found no significant differences. Conclusion: SILC does not have any special advantages over CLC with regard to surgical outcomes, but it can be a safe alternative to CLC, especially in patients concerned about cosmoses.
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Affiliation(s)
- Seyed Vahid Hosseini
- Professor of General Surgery, Fellowship of Colorectal Surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zhabiz Solhjou
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeedeh Pourahmad
- Department of Biostatistics Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Khairallah Muzhir Gabash
- Department of Surgery, Al-Karama Teaching Hospital Medical College, Wasit University, Wasit, Iraq
| | - Ali Bagherpourjahromi
- Department of Colorectal Surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Department of Clinical Epidemiology, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Bahrami
- Department of General Surgery, Fellowship of Colorectal Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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Preliminary evaluation of the SimPORTAL major vessel injury (MVI) repair model. Surg Endosc 2015; 30:1405-12. [DOI: 10.1007/s00464-015-4344-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 06/12/2015] [Indexed: 12/28/2022]
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Chandrasinghe PC, De Silva A, Deen KI. Novel use of Absorbable Modified Polymer (AMP®); EndoClot™ as an adjunct in the management of bleeding from the liver bed during laparoscopic cholecystectomy. SPRINGERPLUS 2015; 4:249. [PMID: 26090300 PMCID: PMC4467801 DOI: 10.1186/s40064-015-1031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/12/2015] [Indexed: 11/10/2022]
Abstract
Absorbable modified polymer (AMP) is a novel local haemostatic agent derived from a natural polysaccharide. Its safety and efficacy has been evaluated in upper and lower gastrointestinal bleeding without reported side effects. We report the safe use of AMP as an adjunct in the management of serious bleeding during laparoscopic cholecystectomy.
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Affiliation(s)
| | - Asantha De Silva
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Kemal Ismail Deen
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Abstract
INTRODUCTION An ideal ligature should tighten readily and remain tight. Ligature failure can be a critical complication of invasive procedures in human and veterinary surgical practice. Previous studies have tested various knots but not the constrictor knot. METHODS A new test bench was employed to compare six ligatures using four suture materials. As tension in a ligature is not readily measured, the study employed a surrogate measurement: the force required to slide a ligature along a rod. Benchmark values tested each suture material wrapped around the rod to establish the ratio between this force and the ligature tension for each material. Each ligature was tested first during tightening and then again afterwards. The benchmark ratios were employed to calculate the tensions to evaluate which ligature and which suture material retained tension best. RESULTS The model provided consistent linear relationships between the tension in the suture and the force required to pull the ligature along the rod. The constrictor knot retained tension in the ligature best (55-107% better than the next best ligature). Among the suture materials, polydioxanone had the greatest ability to retain the tension in a ligature and polyglactin the least. CONCLUSIONS The constrictor knot showed superior characteristics for use as a ligature, and should be introduced into teaching and clinical practice for human and veterinary surgery. The new test bench is recommended for future testing of ligatures as well as objective comparison of suture materials.
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Emir S, Bali İ, Sözen S, Yazar FM, Kanat BH, Gürdal SÖ, Özkan Z. The efficacy of fibrin glue to control hemorrhage from the gallbladder bed during laparoscopic cholecystectomy. ULUSAL CERRAHI DERGISI 2013; 29:158-61. [PMID: 25931869 DOI: 10.5152/ucd.2013.2319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/24/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of the study is to report our experience with fibrin glue application in the management of bleeding from the gallbladder bed during laparoscopic cholecystectomy, which could not be controlled by conventional methods. MATERIAL AND METHODS Three hundred eighty-two patients underwent laparoscopic cholecystectomy. Fourteen patients with bleeding from the gallbladder bed, which could not be controlled by conventional methods, were analyzed retrospectively. RESULTS Fibrin glue was used in 10 patients. Six (71%) were female and 4 were (29%) male. The mean age was 55.7 years. Fourteen patients were operated for the presence of symptomatic gallstones. Thirteen patients (92%) had a concomitant pathology. The mean time spent to maintain hemostasis was 23.9 minutes (15-35). Blood products were used in two patients with hemoglobin values under 8 mg/dL. Hemostasis could not be achieved in a patient despite fibrin glue application, and the operation was converted to open surgery. CONCLUSION The application of fibrin glue for bleeding from the gallbladder bed during laparoscopic cholecystectomy can reduce conversion rates, further studies including more patients are required.
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Affiliation(s)
- Seyfi Emir
- Department of General Surgery, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - İlhan Bali
- Department of General Surgery, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Selim Sözen
- Department of General Surgery, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Fatih Mehmet Yazar
- Department of General Surgery, Elazığ Teaching and Training Hospital, Elazığ, Turkey
| | - Burhan Hakan Kanat
- Department of General Surgery, Elazığ Teaching and Training Hospital, Elazığ, Turkey
| | - Sibel Özkan Gürdal
- Department of General Surgery, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Zeynep Özkan
- Department of General Surgery, Elazığ Teaching and Training Hospital, Elazığ, Turkey
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Dexter F, Epstein RH, Bayman EO, Ledolter J. Estimating Surgical Case Durations and Making Comparisons Among Facilities. Anesth Analg 2013; 116:1103-1115. [DOI: 10.1213/ane.0b013e31828b3813] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Koo EJ, Youn SH, Baek YH, Roh YH, Choi HJ, Kim YH, Jung GJ. Review of 100 cases of single port laparoscopic cholecystectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:179-84. [PMID: 22403752 PMCID: PMC3294112 DOI: 10.4174/jkss.2012.82.3.179] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/26/2012] [Accepted: 01/30/2012] [Indexed: 12/28/2022]
Abstract
Purpose Single port laparoscopic cholecystectomy (SPLC) is a new advanced technique in laparoscopic surgery. Many laparoscopic surgeons seek to gain skill in this new technique. However, little data has been accumulated and published formally yet. This article reports the achievement of 100 cases of SPLC with the hopes it will encourage laparoscopic surgery centers in the early adoption of SPLC. Methods A retrospective review of 100 prospectively selected cases of SPLC was carried out. All patients had received elective SPLC by a single surgeon in our center from May 2009 to December 2010. Our review suggests patients' character, perioperative data and postoperative outcomes. Results Forty-two men and 58 women with an average age of 45.8 years had received SPLC. Their mean body mass index (BMI) was 23.85 kg/m2. The mean operating time took 76.75 minutes. However, operating time was decreased according to the increase of experience of SPLC cases. Twenty-one cases were converted to multi-port surgery. BMI, age, previous low abdominal surgical history did not seem to affect conversion to multi-port surgery. No cases were converted to open surgery. Mean duration of hospital stay was 2.18 days. Six patients had experienced complications from which they had recovered after conservative treatment. Conclusion SPLC is a safe and practicable technique. The operating time is moderate and can be reduced with the surgeon's experience. At first, strict criteria was indicated for SPLC, however, with surgical experience, the criteria and area of SPLC can be broadened. SPLC is occupying a greater domain of conventional laparoscopic cholecystectomy.
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Affiliation(s)
- Eun Jung Koo
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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Thakur SK. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg 2011; 7:200. [PMID: 22022107 PMCID: PMC3193765 DOI: 10.4103/0972-9941.83516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sudhir Kumar Thakur
- Department of Surgery, Saraswathi Institute of Medical Sciences, Hapur, Ghaziabad, Uttar Pradesh, India
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