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Coaston TN, Vadlakonda A, Curry J, Mallick S, Le NK, Branche C, Cho NY, Benharash P. Association of severe obesity with risk of conversion to open in laparoscopic cholecystectomy for acute cholecystitis. Surg Open Sci 2024; 20:1-6. [PMID: 38873329 PMCID: PMC11166894 DOI: 10.1016/j.sopen.2024.05.005] [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: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Background Obesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC). Methods Adult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017-2020 Nationwide Readmissions Database. Patients were stratified by obesity class; class 1 (Body Mass Index [BMI] = 30.0-34.9), class 2 (BMI = 35.0-39.9), and class 3 (BMI ≥ 40.0). Multivariable regression models were developed to assess factors associated with CTO and its association with perioperative complications and resource utilization. Results Of 89,476 patients undergoing LC, 40.6 % had BMI ≥ 40.0. Before adjustment, class 3 obesity was associated with increased rates of CTO compared to class 1-2 (4.6 vs 3.8 %; p < 0.001). Following adjustment, class 3 remained associated with an increased likelihood of CTO (Adjusted Odds Ratio [AOR] 1.45, 95 % Confidence Interval [CI] 1.31-1.61; ref.: class 1-2). Patients undergoing CTO had increased risk of blood transfusion (AOR 3.27, 95 % CI 2.54-4.22) and respiratory complications (AOR 1.36, 95 % CI 1.01-1.85). Finally, CTO was associated with incremental increases in hospitalization costs (β + $719, 95 % CI 538-899) and length of stay (LOS; β +2.20 days, 95 % CI 2.05-2.34). Conclusions Class 3 obesity is a significant risk factor for CTO. Moreover, CTO is associated with increased hospitalization costs and LOS. As the prevalence of obesity grows, improved understanding of operative risk by approach is required to optimize clinical outcomes. Our findings are relevant to shared decision-making and informed consent.
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Affiliation(s)
- Troy N. Coaston
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Amulya Vadlakonda
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Joanna Curry
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Saad Mallick
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Nguyen K. Le
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Corynn Branche
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Nam Yong Cho
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- Department of Surgery, University of California, Los Angeles, CA, USA
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2
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Lombardi PM, Mazzola M, Veronesi V, Granieri S, Cioffi SPB, Baia M, Del Prete L, Bernasconi DP, Danelli P, Ferrari G. Learning curve of laparoscopic cholecystectomy: a risk-adjusted cumulative summation (RA-CUSUM) analysis of six general surgery residents. Surg Endosc 2023; 37:8133-8143. [PMID: 37684403 DOI: 10.1007/s00464-023-10345-x] [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: 03/16/2023] [Accepted: 07/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LapC) is one of the most frequently performed surgical procedures worldwide. Reaching technical competency in performing LapC is considered one essential task for young surgeons. Investigating the learning curve for LapC (LC-LapC) may provide important information regarding the learning process and guide the training pathway of residents, improving educational outcomes. The present study aimed to investigate LC-LapC among general surgery residents (GSRs). METHODS Operative surgical reports of consecutive patients undergoing LapC performed by GSRs attending the General Surgery Residency Program at the University of Milan were analysed. Data on patient- and surgery-related variables were obtained from the ICD-9-CM diagnosis codes and gathered. A multidimensional assessment of the LC was performed through Cumulative Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis. RESULTS 340 patients operated by 6 GSRs were collected. The CUSUM and RA-CUSUM graphs based on surgical failures allowed to distinguish two defined phases for all GSRs: an initial phase ending at the peak, so-called learning phase, followed by a phase in which there was a significant decrease in failure incidence, so-called proficiency phase. The learning phase was completed for all GSRs at most within 25 procedures, but the trend of the curves and the number of procedures needed to achieve technical competency varied among operators ranging between 7 and 25. CONCLUSIONS The present study suggested that at most 25 procedures might be sufficient to acquire technical competency in LapC. The variability in the number of procedures needed to complete the LC, ranging between 7 and 25, could be due to the heterogeneous scenarios in which LapC was performed, and deserves to be investigated through a prospective study involving a larger number of GSRs and institutions.
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Affiliation(s)
- Pietro Maria Lombardi
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Valentina Veronesi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Marco Baia
- Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Del Prete
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico di Milan - General Surgery and Transplant Unit, Milan, Italy
- University of Milan - Translational Medicine PhD Program, Milan, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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Bikini Line Approach for Cosmetic Laparoscopic Cholecystectomy. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03524-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Four-port laparoscopic cholecystectomy (LC) is a standard procedure. Several alternative approaches have been described to make trocar scars invisible. This study describes and was successfully administered as a pilot for feasibility and safety of a bikini line port for better aesthetic results. In patients with symptomatic cholelithiasis undergoing LC between June 2021 and December 2021, bikini line ports were used in 67 patients. With the patient in the supine position, the first trocar (11 mm) was inserted into the abdomen through the umbilicus. The other three trocars were placed in the lower abdomen at the bikini line with the help of the camera. Standard instruments were used to perform the surgery. The mean operative time was 54.66 SD 14.1 min. No intraoperative or postoperative adverse events took place. The median follow-up for this cohort was 24 weeks. Cosmetic results were satisfactory for all patients. The use of one umbilical camera port and the other three ports in the bikini line in the lower abdomen completely hides the scars from the ports’ incision. The technique was quickly adopted by regular laparoscopic surgeons with usual instruments, much to the satisfaction of patients.
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Laparoscopic cholecystectomy - A safe and feasible procedure in patients with mild-moderate acute cholecystitis: A single center, prospective, observational study. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.978789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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5
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Rizan C, Bhutta MF. Environmental impact and life cycle financial cost of hybrid (reusable/single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy. Surg Endosc 2022; 36:4067-4078. [PMID: 34559257 PMCID: PMC9085686 DOI: 10.1007/s00464-021-08728-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/06/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated. METHODS We used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents. We modelled this using SimaPro and ReCiPe midpoint and endpoint methods to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. We also conducted life cycle cost analysis of products, taking into account unit cost, decontamination, and disposal costs. RESULTS The environmental impact of using hybrid instruments for a laparoscopic cholecystectomy was lower than single-use equivalents across 17 midpoint environmental impacts, with mean average reductions of 60%. The carbon footprint of using hybrid versions of all three instruments was around one-quarter of single-use equivalents (1756 g vs 7194 g CO2e per operation) and saved an estimated 1.13 e-5 DALYs (disability adjusted life years, 74% reduction), 2.37 e-8 species.year (loss of local species per year, 76% reduction), and US $ 0.6 in impact on resource depletion (78% reduction). Scenario modelling indicated that environmental performance of hybrid instruments was better even if there was low number of reuses of instruments, decontamination with separate packaging of certain instruments, decontamination using fossil-fuel-rich energy sources, or changing carbon intensity of instrument transportation. Total financial cost of using a combination of hybrid laparoscopic instruments was less than half that of single-use equivalents (GBP £131 vs £282). CONCLUSION Adoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery and also save money.
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Affiliation(s)
- Chantelle Rizan
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK ,Brighton and Sussex Medical School, Brighton, UK ,Centre for Sustainable Healthcare, Oxford, UK ,Royal College of Surgeons of England, London, UK
| | - Mahmood F. Bhutta
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK ,Brighton and Sussex Medical School, Brighton, UK ,BMA Medical Fair and Ethical Trade Group, British Medical Association, London, UK
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Ambasta S, Kulhari S, Shamshery C, Agarwal A, Singh R, Srivastava M. Postoperative analgesic efficacy of quadratus lumborum block in patients undergoing laparoscopic cholecystectomy: A retrospective study. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Reitano E, de'Angelis N, Schembari E, Carrà MC, Francone E, Gentilli S, La Greca G. Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review. ANZ J Surg 2021; 91:E554-E560. [PMID: 34180567 PMCID: PMC8518700 DOI: 10.1111/ans.17021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023]
Abstract
Background Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. Methods A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle–Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. Results Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut‐off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. Conclusions The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.
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Affiliation(s)
- Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Nicola de'Angelis
- Department of Minimally Invasive and Robotic Surgery, "F. Miulli" Regional General Hospital, Acquaviva delle Fonti (BA), Italy
| | - Elena Schembari
- Department of Biomedical and Biotechnological sciences, University of Catania, Catania, Italy
| | - Maria Clotilde Carrà
- Department of Odontology, Rothschild University Hospital, Paris, France.,University Paris Diderot, Paris, France
| | - Elisa Francone
- Division of General Surgery, Department of Health Science, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Sergio Gentilli
- Division of General Surgery, Department of Health Science, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Gaetano La Greca
- Department of Biomedical and Biotechnological sciences, University of Catania, Catania, Italy
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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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9
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Kulkarni AA, Sharma G, Deo KB, Jain T. Umbilical port versus epigastric port for gallbladder extraction in laparoscopic cholecystectomy: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Surgeon 2021; 20:e26-e35. [PMID: 33888427 DOI: 10.1016/j.surge.2021.02.009] [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: 07/18/2020] [Revised: 12/04/2020] [Accepted: 02/15/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND After laparoscopic cholecystectomy, gallbladder can be extracted either from epigastric/subxiphoid port or umbilical port. We conducted systematic review of randomized controlled trials comparing the two. METHODS PRISMA-compliant systematic review and meta-analysis was conducted with pre-specified study protocol registered on PROSPERO (CRD42019128662). Multiple databases were searched from inception till 14 September 2019 using search terms "gallbladder", "specimen", "extraction', "extract", "cholecystectomy", "epigastric port", "subxiphoid port" "umbilical port". Outcomes assessed were postoperative pain (visual analog scale at 24 h postoperatively), port-site hernia, port-site infection, operative time and gallbladder retrieval time. Data were analyzed using random-effects models with risk ratios (RR) for dichotomous variables and mean difference (MD) for continuous variables. RESULTS Of 280 articles retrieved, 9 RCT's with 1036 participants were included. Quality of included studies was judged to be "moderate" to "low". There was no difference in postoperative pain at 24 h (p = 0.76), total operative time (p = 0.11), gallbladder retrieval time (p = 0.72) or surgical site infection (p = 0.93). Umbilical port retrieval was associated with significantly higher risk of port-site herniae (RR 2.68, 95%CI:1.06-6.80, p = 0.04). After sensitivity analysis, operative time was significantly shorter with epigastric retrieval (p = 0.0007). Trial sequential analysis showed that current studies were successful in achieving optimum information size for primary outcome. CONCLUSIONS There was no difference in postoperative pain and infections between umbilical and epigastric port retrieval. Umbilical port retrieval was associated with significantly higher risk of developing port-site hernia and could also be associated with longer operative time. Epigastric port may be favorable for gallbladder retrieval in multiport laparoscopic cholecystectomy.
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Affiliation(s)
- Aditya A Kulkarni
- Department of Surgery, B. J. Medical College and Sassoon General Hospital, Pune, India; Division of Surgical Gastroenterology, Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kunal Bikram Deo
- Division of Surgical Gastroenterology, Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tanvi Jain
- Division of Surgical Gastroenterology, Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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10
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Fong ML, Urriza Rodriguez D, Elberm H, Berry DP. Are Type and Screen Samples Routinely Necessary Before Laparoscopic Cholecystectomy? J Gastrointest Surg 2021; 25:447-451. [PMID: 31993966 DOI: 10.1007/s11605-020-04515-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023]
Abstract
AIMS Type and screen (T&S) samples are routinely requested before all laparoscopic cholecystectomies (LCs) at our centre despite the low reported risk of major vascular injury and peri-operative transfusion. Our retrospective case series aimed to identify local transfusion need to inform policy. METHODS Emergency and elective LC performed at a single tertiary centre between March 2014 and October 2016 (30 months) were analysed. This included all patients aged ≥ 16, and procedures converted to open where LC was the primary procedure. Peri-operative complications and transfusion data were obtained from electronic records. RESULTS In total, 1002 consecutive patients met inclusion criteria; 12 patients were transfused during index admission (1.20%). No patients required emergency transfusion or had major vascular injuries. Despite local policy, 106 patients (10.6%) did not have a valid T&S sample prior to their procedure. Transfused patients were more likely to be emergency admissions (n = 10/12). The most common indications for transfusion were pre-operative anaemia (n = 7/12) and septic coagulopathy (n = 2/12). CONCLUSIONS Peri-operative transfusions at our centre were low. No patients required intra-operative blood transfusions dependent on a pre-operative T&S sample. Patients requiring transfusion were predictable from their pre-operative clinical status. We propose that a highly selective T&S policy is safe and can reduce costs.
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Affiliation(s)
- M L Fong
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK.
| | - D Urriza Rodriguez
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK
| | - H Elberm
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK
| | - D P Berry
- Department of Surgery, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK
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Alsharedah AH, Alotaibi SM, Khan BF, Alshaibani AK, Algarni SA. Laparoscopic Management of Gallbladder Duplication: A Case Report. Cureus 2020; 12:e10675. [PMID: 33133841 PMCID: PMC7592526 DOI: 10.7759/cureus.10675] [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] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic cholecystectomy has become one of the most commonly performed abdominal surgeries worldwide. Several anatomic variations and congenital malformations in the gallbladder and biliary anatomy have been described. We reported the case of a middle-aged woman who presented with jaundice and abdominal pain. Her laboratory investigations revealed an elevated bilirubin level (mainly the direct component). The patient showed an improvement in the clinical and laboratory parameters after conservative management. Then, the patient was prepared for a laparoscopic cholecystectomy which revealed a duplication of the gallbladder with two distinct cystic ducts draining independently to the common bile duct. The procedure was completed uneventfully. This type of gallbladder duplication is among the least common types. The case highlights the importance of having a meticulous intraoperative evaluation of the biliary anatomy to avoid potential complications and injuries.
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Affiliation(s)
- Ali H Alsharedah
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Sarah M Alotaibi
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Basim F Khan
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Askar K Alshaibani
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Saad A Algarni
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Almnaizel T, Alnawafleh T, Al-Jarrah R, Al-Abadi AM, Al-Omari MA, Al-Oudat EA. Hartmann pouch herniation in Calot's triangle: A case report. Int J Surg Case Rep 2020; 72:175-177. [PMID: 32540680 PMCID: PMC7298520 DOI: 10.1016/j.ijscr.2020.05.022] [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: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022] Open
Abstract
There are many atypical anatomic structural variations of the biliary tree. The anatomical variations can be diagnosed either intra-operatively or pre-operatively. Surgeon’s experience and knowledge are essential to form the best surgical decision. A second opinion of a hepatobiliary surgeon decreases avoidable complex injury to biliary tract in selective cases. Fine handling of hepatocystic triangle and skeletonization of porta hepatis are the main principles of surgery.
Introduction Laparoscopic cholecystectomy is one of the most frequent operations performed around the world. Some pathological findings are particularly rare and difficult to diagnose preoperatively. Here, we report a case of a patient who presented to our hospital with calculus cholecystitis with a unique Intraoperative finding of Hartmann pouch herniation through hepatocystic triangle. The aim of the study is to consider Hartmann pouch herniation as a rare differential diagnosis of gallbladder stone complication. Presentation of case We present a 48-year-old male who came to our emergency department complaining of constant epigastric abdominal pain lasting 3 h with vomiting. Utilizing chemistry laboratory studies and radiological studies, the final diagnosis was acute calculus cholecystitis. Early laparoscopic cholecystectomy was done and revealed Hartmann pouch herniation through the Calot’s triangle. This herniation resulted in strangulation of the Hartmann pouch and displacement of the cystic duct and artery anteriorly. Discussion The biliary tract is liable for congenital anomalies. These anatomical variations can be diagnosed either intra-operatively or pre-operatively using radiological imaging. Hartmann pouch herniation is a new finding that we encountered in this case. Conclusion Profound surgeons’ anatomical knowledge is essential for the safety of patients, especially for hepatobiliary surgeries due to the wide variations in normal and pathological anatomy. Using critical view of safety can decrease avoidable complications. Consulting specialized hepatobiliary surgeon is preferred when dealing with such cases.
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Affiliation(s)
- Tariq Almnaizel
- Department of General Surgery, King Hussein Medical Center (KHMC), Amman, Jordan.
| | - Tawfiq Alnawafleh
- Department of General Surgery, King Hussein Medical Center (KHMC), Amman, Jordan.
| | - Ra'ed Al-Jarrah
- Department of General Surgery, King Hussein Medical Center (KHMC), Amman, Jordan.
| | | | - Malek A Al-Omari
- Department of General Surgery, King Hussein Medical Center (KHMC), Amman, Jordan.
| | - Eman A Al-Oudat
- Department of Pulmonology, King Hussein Medical Center (KHMC), Amman, Jordan.
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13
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Pneumoperitoneum in Veterinary Laparoscopy: A Review. Vet Sci 2020; 7:vetsci7020064. [PMID: 32408554 PMCID: PMC7356543 DOI: 10.3390/vetsci7020064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO2 insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO2 insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.
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Laparoscopic to Open Cholecystectomy: The Risk Factors and the Reasons; A Retrospective Analysis of 1950 Cases of a Single Tertiary Center. Surg Laparosc Endosc Percutan Tech 2019; 30:192-195. [DOI: 10.1097/sle.0000000000000716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10-mm Laparo-Endoscopic Single-Site Cholecystectomy Using Multiple Magnetically Anchored and Controlled Instruments. J Surg Res 2019; 239:166-172. [DOI: 10.1016/j.jss.2019.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/22/2019] [Accepted: 02/06/2019] [Indexed: 12/11/2022]
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16
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Scott JE, Singh A, Valverde A, Blois SL, Foster RA, Kilkenny JJ, Linden AZ. Effect of pneumoperitoneum with warmed humidified or standard-temperature carbon dioxide during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs. Am J Vet Res 2019; 79:1321-1334. [PMID: 30457909 DOI: 10.2460/ajvr.79.12.1321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate effects of pneumoperitoneum created with warmed humidified CO2 (WHCO2) during laparoscopy on core body temperature, cardiorespiratory and thromboelastography variables, systemic inflammation, peritoneal response, and signs of postoperative pain in healthy mature dogs. ANIMALS 6 mature purpose-bred dogs. PROCEDURES In a randomized crossover study, each dog was anesthetized twice, and pneumoperitoneum was created with standard-temperature CO2 (STCO2; 22°C and 0% relative humidity) and WHCO2 (37°C and 98% relative humidity). Data were collected during each procedure, including core body temperature, cardiorespiratory and thromboelastography variables, and inflammatory biomarkers. Peritoneal biopsy specimens were collected and evaluated with scanning electron microscopy. Dogs were assessed for signs of postoperative pain. RESULTS Mean core body temperature was significantly lower (35.2°C; 95% confidence interval, 34.5° to 35.8°C) with WHCO2 than with STCO2 (35.9°C; 95% confidence interval, 35.3° to 36.6°C) across all time points. Cardiac index increased during the procedure for both treatments but was not significantly different between treatments. Thromboelastography variables did not differ significantly between treatments as indicated by the coagulation index. Subjective evaluation of peritoneal biopsy specimens revealed mesothelial cell loss with STCO2. There was no significant difference in circulating C-reactive protein or interleukin-6 concentrations. There was a significant increase in the number of postoperative pain scores > 0 for the WHCO2 treatment versus the STCO2 treatment. CONCLUSIONS AND CLINICAL RELEVANCE Analysis of these data suggested that effects on evaluated variables attributable to the use of WHCO2 for creating pneumoperitoneum in healthy mature dogs undergoing laparoscopy did not differ from effects for the use of STCO2.
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Gangemi A, Danilkowicz R, Bianco F, Masrur M, Giulianotti PC. Risk Factors for Open Conversion in Minimally Invasive Cholecystectomy. JSLS 2018; 21:JSLS.2017.00062. [PMID: 29238153 PMCID: PMC5714218 DOI: 10.4293/jsls.2017.00062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: Open conversion (OC) occurs in 5 to 10% of laparoscopic cholecystectomies (LCs) and results in suboptimal outcomes. Herein, we report our experience with OC in cholecystectomy performed with the minimally invasive (MIS) approach. Methods: Data from 960 minimally invasive cholecystectomies performed in the University of Illinois at Chicago (UIC) Division of General, Minimally Invasive, and Robotic Surgery were retrospectively compiled. Patient demographics and outcomes were analyzed for the major indicators that may predispose to OC. Results: Male gender and intraoperative diagnosis of acute or gangrenous cholecystitis were identified as statistically significant individual predictors for OC. Conversion incidence was significantly lower in every paired demographic combination when compared with the laparoscopic data. Conclusions: Our retrospective study identified some specific factors associated with significantly higher risk of OC in both laparoscopic and robotic cholecystectomy. The impact of these risk factors seems to be lesser in the robotic than in the laparoscopic approach. Further investigation is necessary to validate these findings.
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Affiliation(s)
- Antonio Gangemi
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Richard Danilkowicz
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Francesco Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Masrur
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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25-Hydroxyvitamin D levels and bone mineral density evaluation in patients with cholecystectomy: a case-control study. Arch Osteoporos 2018; 13:14. [PMID: 29500745 DOI: 10.1007/s11657-018-0435-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/08/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study compared the 25-hyrdoxyvitamin (OH) D and bone mineral density (BMD) values of patients with and without cholecystectomy. Although 25(OH) D levels were significantly lower in the cholecystectomy group (12.1 ± 6.2 vs. 15.6 ± 6.6 ng/mL), no significant difference was observed between the groups in terms of BMD measurements. INTRODUCTION Although 25 (OH) D levels were studied and found to be lower in patients with cholecystectomy, the data is scarce as regards the BMD. Therefore, the aim of this study was to compare the 25(OH) D and BMD values of patients with cholecystectomy and without cholecystectomy. METHODS This study was a single-center and case-control trial. The cholecystectomy group comprised the patients with a history of cholecystectomy. In addition, a healthy control group without history of cholecystectomy was defined. All patients were selected consecutively from the patients who admitted to the outpatient clinics of physical and rehabilitation medicine or internal medicine between the June 2016 and August 2016. The patients were ambulatory and did not receive any osteoporosis treatment before. Chemiluminescence microparticle immunoassay method was used for 25(OH) D measurements. Dual-energy X-ray absorptiometry was used for the BMD evaluations. RESULTS There were 46 patients in the cholecystectomy group with a mean age of 58.6 ± 14.1 years and 64 patients in the control group with a mean age of 59.2 ± 13.3 years. Although 25(OH) D levels were significantly lower in the cholecystectomy group (12.1 ± 6.2 vs. 15.6 ± 6.6 ng/mL) (p = 0.010), no significant difference was observed between the groups in terms of BMD measurements (p > 0.05). While there was a weak positive correlation between the BMI and BMD measurements (all p < 0.05), linear regression analyses showed that the models were not valid (femoral neck R = 0.092; femur total R = 0.170; and lumbar total R = 0.199). No significant difference was observed between the BMD measurements and time after cholecystectomy in the cholecystectomy group (p > 0.05). CONCLUSION In the light of our results, cholecystectomy patients seem to have lower level of 25(OH) D levels in comparison with healthy subjects, but both groups have similar BMD values. Further studies in cohort designs taking into account the bone formation and resorption markers are awaited.
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Harilingam MR, Shrestha AK, Basu S. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience. J Minim Access Surg 2016; 12:325-9. [PMID: 27251818 PMCID: PMC5022512 DOI: 10.4103/0972-9941.181323] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: Laparoscopic cholecystectomy (LC) is considered the ‘gold standard’ intervention for gall bladder (GB) diseases. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot's triangle. The aim is to find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable, with an acceptable morbidity and outcome. PATIENTS AND METHODS: A retrospective analysis of prospectively collected data of 993 consecutive patients who underwent cholecystectomy was done at a large District General Hospital (DGH) between August 2007 and January 2015. The data are as follows: Patient's demographics, operative details including intra- and postoperative complications, postoperative stay including follow-up that was recorded and analysed. RESULTS: A total of 993 patients (263 males and 730 female) were included. The median age was 52*(18-89) years. Out of the 993 patients, 979 (98.5%) and 14 (1.5%) were listed for laparoscopic and open cholecystectomy, respectively. Of the 979 patients, 902 (92%) and 64 (6.5%) patients underwent LC ± on-table cholangiography (OTC) and LMSC ± OTC, respectively, with a median stay of 1* (0-15) days. Of the 64 patients, 55 (86%) had dense adhesions, 22 (34%) had acute inflammation, 19 (30%) had severe contraction, 12 (19%) had empyema, 7 (11%) had Mirizzi's syndrome and 2 (3%) had gangrenous GB. The mean operative time was 120 × (50-180) min [Table 1]. Six (12%) patients required endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and there were four (6%) readmissions in a follow-up of 30 × (8-76) months. The remaining 13 (1.3%) patients underwent laparoscopic cholecystectomy converted to an open cholecystectomy. The median stay for open/laparoscopic cholecystectomy converted to open cholecystectomy was 5 × (1-12) days. CONCLUSION: Our technique of LMSC avoided conversion in 6.5% patients and believe that it is feasible and safe for difficult GBs with a positive outcome.
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Affiliation(s)
| | | | - Sanjoy Basu
- Department of Surgery, William Harvey Hospital, Ashford, Kent, UK
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Scott J, Singh A, Mayhew PD, Brad Case J, Runge JJ, Gatineau M, Kilkenny J. Perioperative Complications and Outcome of Laparoscopic Cholecystectomy in 20 Dogs. Vet Surg 2016; 45:O49-O59. [DOI: 10.1111/vsu.12534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Jacqueline Scott
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Ameet Singh
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - J. Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville Florida
| | - Jeffrey J. Runge
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania; Philadelphia Pennsylvania
| | | | - Jessica Kilkenny
- Department of Clinical Studies; Ontario Veterinary College, University of Guelph; Guelph Ontario Canada
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Sudden Death Due to Bilateral Pulmonary Thromboembolism Following Laparoscopic Cholecystectomy. Am J Forensic Med Pathol 2016; 37:198-200. [PMID: 27356014 DOI: 10.1097/paf.0000000000000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cases of sudden death due to pulmonary thromboembolism (PTE) following laparoscopic surgery are very rare. The risk factors for PTE include sex, operation duration, age, obesity, and underlying diseases. The development of thromboprophylaxis according to specific risk factors has contributed to the decrease in postoperative mortality. Here, we describe the case of a 50-year-old patient with sudden death due to PTE at 24 hours after laparoscopic cholecystectomy. The origin of the thrombi were bilateral deep vein thromboses in both the lower extremities. No severe risk factors for PTE were detected in the patient, and pneumatic compression devices were used during the surgery for thromboprophylaxis. We believe that the accumulation of minor risk factors may have contributed to the onset of PTE. Hence, a more cautious assessment of the risk factors for PTE prior to surgery is required in such cases.
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Prospective randomized controlled trial comparing standard analgesia with combined intra-operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy. Surg Endosc 2016; 31:704-713. [DOI: 10.1007/s00464-016-5024-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/04/2016] [Indexed: 11/25/2022]
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Zhu HY, Li F, Li KW, Zhang XW, Wang J, Ji F. Transumbilical endoscopic cholecystectomy in a porcine model. Acta Cir Bras 2014; 28:762-6. [PMID: 24316742 DOI: 10.1590/s0102-86502013001100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/21/2013] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Natural orifice transluminal endoscopic surgery (NOTES) is a new technique. This study describes our initial experience of NOTES and investigates the feasibility of transumbilical endoscopic cholecystectomy (TUEC). METHODS Eight domestic pigs were submitted to TUEC. After establishment of pneumoperitoneum, a bi-channel endoscope was placed through an infra-umbilical trocar. The gallbladder fundus was lifted by a grasper. The cystic duct and artery was dissected with a flexible hook and clipped by a clip fixing device. The specimen was extracted through the infra-umbilical trocar. RESULTS The mean operation time was 114 minutes, ranging from 75 to 155 minutes. All the gallbladders were removed successfully. There was one case of subtotal resection, two cases of bleeding and three cases of bile leakage. CONCLUSION Transumbilical endoscopic cholecystectomy is feasible although it needs more support of experiments and techniques before being applied on human subjects.
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Gonzalez AM, Rabaza JR, Donkor C, Romero RJ, Kosanovic R, Verdeja JC. Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms. Surg Endosc 2013; 27:4524-31. [PMID: 23943118 DOI: 10.1007/s00464-013-3105-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/04/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many series have shown the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC), but this technique still has limitations such as instrument collisions and lack of triangulation. Recently, two single-incision platforms, robotic and SPIDER, have attempted to ameliorate such problems. This study aimed to compare three different techniques of single-incision cholecystectomy: standard laparoscopic, robotic, and SPIDER approaches. METHODS The authors retrospectively collected data from their first 166 single-incision robotic cholecystectomies (SIRCs) and compared the findings with the data from their first 166 SILCs and the first 166 s-generation SPIDER procedures. All the SILCs were performed with three trocars placed in one umbilical incision and with gallbladder retraction using a Prolene stitch on the right upper quadrant. All the robotic cases were managed using the da Vinci Single-Site Surgical System, and all the SPIDER procedures were performed using the SPIDER Surgical System. RESULTS The SILC, SIRC, and SPIDER groups consisted respectively of 129 (76.3%), 131 (78.9%), and 136 (81.9%) women with the respective mean ages of 44.5 ± 14.3, 51.6 ± 15.9, and 46.4 ± 15.2 years. The mean body mass indexes (BMIs) were respectively 29.1 ± 5.6, 29.4 ± 6.2, and 27.5 ± 4.8 kg/m(2), and the mean surgical times were 37.1 ± 13.3, 63.0 ± 25.2, and 52.8 ± 18.7 min. The total hospital stays were respectively 1.3 ± 5.3, 1.2 ± 2.2, and 1.5 ± 2.6 days, and complications were seen respectively in three SILC cases (1.8%), three SIRC cases (1.8%), and two SPIDER cases (1.2%). CONCLUSIONS The results of this study demonstrate similar results among the three platforms for most of the parameters measured. The SILC procedure appears to be superior to SIRC and SPIDER in terms of surgical time, but selection bias could be the cause. The SILS, SIRC, and SPIDER procedures all are similar in terms of complication profile. It can be concluded that SILC, SIRC, and SPIDER all are feasible and safe alternatives when used for single-incision cholecystectomy.
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