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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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Abulfaraj M. A Detached Gallbladder Situated Below the Transverse Colon: A Case Report of an Unusual Position. Cureus 2023; 15:e50245. [PMID: 38196422 PMCID: PMC10774072 DOI: 10.7759/cureus.50245] [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] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
This report presents an unforeseen event involving the detachment of the gallbladder without any traumatic cause, which was incidentally detected during a scheduled laparoscopic cholecystectomy procedure. The incidence of total congenital gallbladder detachment from the liver is quite uncommon. The primary difficulty encountered in patients afflicted with this particular medical issue pertains to the intraoperative identification and localization of the gallbladder. The significance of this case report lies in its presentation of a groundbreaking finding that has the potential to provide challenges for surgeons doing laparoscopic cholecystectomy, a commonly performed surgical procedure.
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Affiliation(s)
- Moaz Abulfaraj
- Division of General Surgery, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
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Gupta R, Kumar A, Hariprasad CP, Kumar M. Anatomical variations of cystic artery, cystic duct, and gall bladder and their associated intraoperative and postoperative complications: an observational study. Ann Med Surg (Lond) 2023; 85:3880-3886. [PMID: 37554913 PMCID: PMC10406088 DOI: 10.1097/ms9.0000000000001079] [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: 04/12/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Anatomical variations in the calots triangle encountered during laparoscopic cholecystectomy are not uncommon. Misidentification and misperception of these structures are the major cause of vasculobiliary injuries. This study was conducted to estimate the prevalence of anatomical variations of the cystic artery, cystic duct (CD), and gall bladder. This is the first study in India to access the rate of intraoperative and postoperative complications in anatomical variants compared to normal individuals. PATIENTS AND METHODS It was a prospective observational study on patients undergoing laparoscopic cholecystectomy in the department of General Surgery at the tertiary center of India. The calculated sample size was 298. Variations of the cystic artery, CD, and gall bladder along with intraoperative and postoperative complications were noted. The comparative analysis of intraoperative and postoperative complications and a subgroup analysis between anatomical variants and normal patients were performed. RESULTS The most common variations were found in cystic arteries (16.8%). CD anomalies were present in 11.4% of patients, and gall bladder anomalies were the least common of all (5.4%). Intraoperative and postoperative complications were compared between patients with anatomical variations and normal anatomy. Intraoperative complications in patients with anatomical variations were significantly higher. Bile leak (15.7% vs. 6.4%) (P=0.01), haemorrhage (16.8% vs. 1.9%) (P-value <0.001), conversion to open (3 vs. 0 patients) (P-value =0.03). Subgroup analysis revealed a strong association between intraoperative haemorrhage and bile leak with cystic artery and CD anomalies, respectively. CONCLUSION Cystic artery anomalies are the most common variations. Patients with anatomical variations had significant intraoperative and postoperative complications compared to patients with normal anatomy.
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Affiliation(s)
| | - Anil Kumar
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, India
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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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5
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Moynihan's hump of the right hepatic artery in Calot's triangle: a systematic review and meta-analysis of its incidence and surgical importance. Surg Radiol Anat 2023; 45:643-651. [PMID: 36932210 DOI: 10.1007/s00276-023-03125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION A rare variation known as "Moynihan's or caterpillar hump" of the right hepatic artery raises the danger of vascular and biliary injuries during hepatobiliary surgery. This research intends to carefully record every case (i.e., patients undergoing laparoscopic cholecystectomy or cadaver dissections) where the right hepatic artery received a caterpillar hump. METHODS The literature search was conducted with the medical subject headings (MeSH) and EMTREE (subject headings unique to Embase) keywords. The keywords with Boolean operators (OR, AND, and NOT) were used to create search strings in all possible combinations to retrieve bibliographic data. Two authors independently performed a risk of bias assessment and data extraction. The random effects model was used to conduct a meta-analysis. RESULTS Thirty studies with a total of 8418 subjects reported that Moynihan's hump was present in 3.81% of them, with a predictive interval of 0.88-16.45%. The incidence of the hump was 3.1% in surgical studies (7496 subjects) and 7.22% (95% CI 4.7-10.93%) in cadaveric data (625 cadavers). Only ten studies addressed the relationship between the caterpillar hump and the common bile duct. CONCLUSION A patient with an unusually "small cystic artery" or "large right hepatic artery" is likely to have a "caterpillar hump". The caterpillar's hump of the right hepatic artery is subject to rare anatomical variations in its course that increase the risk of incorrect vessel ligation or injury during laparoscopic cholecystectomy.
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Ibrarullah M, Mohanty L, Mishra A, Panda A, Sikora SS. Anatomical appraisal of safe cholecystectomy: a prospective study. ANZ J Surg 2023; 93:1329-1334. [PMID: 36921100 DOI: 10.1111/ans.18387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Principles of safe cholecystectomy include dissection of the hepatocystic triangle and identification of the bilio-vascular structures to achieve critical view of safety. The aim of the present study was to document the variations in anatomical landmarks and bilio-vascular structures exposed during laparoscopic cholecystectomy. METHODS All consecutive patients who underwent laparoscopic cholecystectomy were included in the study. Recommended techniques of safe cholecystectomy were followed. Rouviere's sulcus was classified into four types. Cystic duct was assessed for its length and diameter. A new classification was suggested for cystic artery. RESULTS Five hundred patients were included in the study. Critical view of safety was achieved in 463 (92.6%) patients. Type1 Rouviere's sulcus was the most common variant found in 263 (52.6%). Normal cystic duct was present in 339 (67.8%). Wide cystic duct of normal length was the most common variant found in 71 (14.2%). Single cystic artery supero-medial to cystic duct (type1-s) was the most common variant found in 384 (76.8%). Inferior cystic artery i.e. artery infero-lateral to cystic duct (type-2) was the second most common variant, found in 40 (8%). Multiple cystic arteries in the hepatocystic triangle were due either to early division of single cystic artery (type-1m) or double cystic artery (type-3). Aberrant right hepatic artery giving off a small cystic artery (type-4) was seen in 12 (2.4%). CONCLUSION Wide variation in the anatomical structures is noted when principles of safe laparoscopic cholecystectomy is followed. Awareness is paramount to avoid bilio-vascular injury during surgery.
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Affiliation(s)
- Mohammad Ibrarullah
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, 751005, India
| | - Laxminarayan Mohanty
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, 751005, India
| | - Abhishek Mishra
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, 751005, India
| | - Ashirbad Panda
- Department of Surgical Gastroenterology, Apollo Hospitals, Bhubaneswar, Odisha, 751005, India
| | - Sadiq S Sikora
- Institute of Digestive & HPB Sciences, Sakra World Hospital, Bangalore, India
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alharbi MB. Liver Paranchyma Orignated accessory cystic artery: Care report and review Article. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Timerbulatov MV, Grishina EE, Aitova LR, Aziev MM. [Modern principles of safety in laparoscopic cholecystectomy]. Khirurgiia (Mosk) 2022:104-108. [PMID: 36469476 DOI: 10.17116/hirurgia2022121104] [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] [Indexed: 06/17/2023]
Abstract
Laparoscopic cholecystectomy has many advantages over open surgery. Nevertheless, incidence of intraoperative bile duct injury is consistently higher for laparoscopic technique. This review is devoted to modern principles of identifying the anatomical elements in hepatoduodenal ligament and rules for safe tissue dissection in this area. The last ones mainly consist in formation of «critical view of safety» before clipping and transection of tubular structures. The key for «critical view of safety» is mobilization of fatty and fibrous tissues of hepatocystic triangle starting from the lower third of the gallbladder.
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Affiliation(s)
| | | | - L R Aitova
- Bashkir State Medical University, Ufa, Russia
| | - M M Aziev
- Ufa City Clinical Hospital No. 21, Ufa, Russia
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9
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Moldovan C, Cochior D, Gorecki G, Rusu E, Ungureanu FD. Clinical and surgical algorithm for managing iatrogenic bile duct injuries during laparoscopic cholecystectomy: A multicenter study. Exp Ther Med 2021; 22:1385. [PMID: 34650633 PMCID: PMC8506945 DOI: 10.3892/etm.2021.10821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022] Open
Abstract
The present study was a multicenter, analytical, nonrandomized research on 108 cases of intraoperative vascular and bile duct lesions during laparoscopic cholecystectomies. We selected these cases from 16,559 cholecystectomies performed entirely laparoscopically or debuted laparoscopically and converted to an open approach. The study included two surgical centers labeled as primary, with extensive experience in hepato-biliary reconstructive surgery, and four other centers labeled as secondary that referred cases to the previous two. Our study analyzed several key parameters such as the percentage of iatrogenic lesions recorded, the variability of the main biliary pathway and conformation as well as its relationship to the adjacent critical anatomical landmarks, the anatomical and physiopathological characteristics of pathology requiring surgical intervention, factors related to laparoscopic surgical technique, the surgical technique used to repair the recorded lesions, the duration of survivability and the rate of the occurring complications. Based on the analysis of these parameters, we developed a descriptive algorithm with visual representation relying on several decisional points to guide the surgeons in choosing the optimal treatment method so that patients will benefit from a favorable clinical path.
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Affiliation(s)
- Cosmin Moldovan
- Faculty of Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania.,General Surgery Ward, 'Witting' Clinical Hospital, 010243 Bucharest, Romania
| | - Daniel Cochior
- Faculty of Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania.,General Surgery, 'Sanador' Clinical Hospital, 010991 Bucharest, Romania.,General Surgery, 'Monza' Clinical Hospital, 021967 Bucharest, Romania
| | - Gabriel Gorecki
- Medicine Doctoral School, 'Titu Maiorescu' University, 040317 Bucharest, Romania
| | - Elena Rusu
- Faculty of Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania
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10
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Manatakis DK, Tasis N, Antonopoulou MI, Agalianos C, Piagkou M, Tsiaoussis J, Natsis K, Korkolis DP. Morphology of the sulcus of the caudate process (Rouviere's sulcus) in a Greek population and a systematic review with meta-analysis. Anat Sci Int 2021; 97:90-99. [PMID: 34542789 DOI: 10.1007/s12565-021-00628-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/05/2021] [Indexed: 01/06/2023]
Abstract
The purpose of this study was to determine the prevalence and to investigate the morphology of the sulcus of the caudate process in a Greek population, along with a systematic review and meta-analysis of the literature. Overall, 103 consecutive patients undergoing laparoscopic cholecystectomy were included in the analysis. The sulcus was present in 91% and three morphological variants were identified (groove 69%, slit 21% and scar 10%). The sulcus had a horizontal course in 90% of patients and a mean length of 25 ± 13 mm. The meta-analysis included 27 surgical and 11 cadaveric studies with 6661 cases in total. The pooled prevalence of the sulcus was 80% and did not differ significantly among various geographical regions. Concerning sulcus subtypes, the binary "open/fused" classification was used to unify the heterogeneous data. The "open" type was more frequent than the "fused" (64.5% vs 35.5%). A horizontal course was observed in 53.5% and an oblique in 45.7%. The sulcus contained the right portal pedicle in 38%, the right posterior portal pedicle in 37%, and the right posteroinferior pedicle in 23.5%. In conclusion, the sulcus of the caudate process is a very helpful anatomical landmark in hepatectomy and laparoscopic cholecystectomy and can be identified in the majority of patients. However, various classifications for the morphological variants and diverse terminology cause discrepancy in the literature and create the need for a single classification system. The proposed 3-tier classification (groove, slit, scar) is simple and easy to remember and avoids ambiguous nomenclature.
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Affiliation(s)
- Dimitrios K Manatakis
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece.
| | - Nikolaos Tasis
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece
| | | | - Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece
| | - Maria Piagkou
- Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Tsiaoussis
- Laboratory of Anatomy, School of Medicine, University of Crete, Heraklion, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fateh O, Wasi MSI, Bukhari SA. Anaotmical variability in the position of cystic artery during laparoscopic visualization. BMC Surg 2021; 21:263. [PMID: 34039316 PMCID: PMC8157651 DOI: 10.1186/s12893-021-01270-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The laparoscopic view of extrahepatic biliary tract and cystic artery is different anatomically from open approach. Consequently iatrogenic injuries due to inadverent damage to cystic artery are not uncommon. These complications can be prevented by careful dissection in Calots triangle and better knowledge of laparoscopic anatomy of cystic artery and its variations. The aim of this study is to establish the prevalence of variation in position of cystic artery in relation to cystic duct. This will help identify the safe area for dissecting peritoneum in Calots triangle and thus help young surgeons overcome the long learning curve associated with laparoscopy. MATERIALS AND METHODS During a 10 year period from January 2009 to January 2019, 1850 laparoscopic cholecystectomies that were performed at a tertiary care hospital were studied. Patients with history of previous abdominal surgery were excluded from the study. Cystic artery was divided into four groups based on its relative position to cystic duct. It includes superomedial, superolateral, anterior and absent cystic artery relative to the cystic duct. RESULTS Out of 1850 cases of laparoscopic cholecystectomy 1676 (90.59%) patients had cystic artery superomedial to cystic duct and 96 (5.19%) had a cystic artery at superolateral position to cystic duct. In 48 (2.59%) patients it was found anterior to cystic duct and in 30 (1.62%) patients it was absent. CONCLUSIONS It is concluded that the most common position of cystic artery is superomedial while the least common position was found to be anterior to cystic duct. Hence it is postulated that blind dissection from anterior side is the safest approach to avoid injury to cystic artery.
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Affiliation(s)
- Omer Fateh
- Department of Surgery, Sindh Government Qatar Hospital, Karachi, Pakistan
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12
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Koong JK, Ng GH, Ramayah K, Koh PS, Yoong BK. Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: A randomised controlled study. Asian J Surg 2020; 44:537-543. [PMID: 33223453 DOI: 10.1016/j.asjsur.2020.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Achieving critical view of safety (CVS) is vital during laparoscopic cholecystectomy (LC). There is no known study determining use of indocyanine green fluorescence cholangiography (ICGFC) in early identification of CVS during LC. This study aims to compare use of ICGFC in LC against conventional LC in early identification of CVS. METHODOLOGY Patients undergoing LC in a single centre were randomized into ICGFC-LC and conventional LC. Surgery was performed by a single surgeon and the time taken to achieve CVS from the time of gallbladder fundus retraction was measured. Difficulty level for each surgery was rated and analysed using a modified scoring system (Level 1- Easy to Level 4-Very difficult). RESULTS 63 patients were recruited where mean time (min) to achieve CVS was 22.3 ± 12.9 in ICGFC-LC (n = 30) and 22.8 ± 14.3 in conventional LC (p = 0.867). The time taken to achieve CVS was shorter in ICGFC-LC group across all difficulty levels, although not significant (p > 0.05). No major complication was observed in the study. CONCLUSIONS This study had shown ICGFC-LC reduces time to CVS across all difficulty levels but not statistically significant. ICGFC-LC maybe useful in difficult LC and in surgical training. TRIAL REGISTRATION Clinical Trials NCT04228835. STUDY GRANT UMMI Surgical - Karl Storz Distributor (Malaysia).
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Affiliation(s)
- Jun Kit Koong
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Gaik Huey Ng
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Kamarajan Ramayah
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Peng Soon Koh
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Boon Koon Yoong
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
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13
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Schendel J, Ball C, Dixon E, Sutherland F. Prevalence of anatomic landmarks for orientation during elective laparoscopic cholecystectomies. Surg Endosc 2019; 34:3508-3512. [DOI: 10.1007/s00464-019-07131-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022]
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