PLACE OF MINILAP CHOLECYSTECTOMY IN AN ERA OF LAPAROSCOPIC CHOLECYSTECTOMY.
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ABSTRACT:
SUBMITTER: Chaturvedi AK
PROVIDER: S-EPMC5531709 | biostudies-other | 1999 Jan
REPOSITORIES: biostudies-other
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Project description:Single-incision laparoscopic surgery also known as laparo-endoscopic single-site surgery for cholecystectomy is performed using a single umbilical skin incision through which a laparoscope and two instruments are introduced. It is virtually a "scarless" surgery. The present study was undertaken to evaluate the efficacy of single-incision laparoscopic cholecystectomy using conventional instruments and compare it with three-port laparoscopic cholecystectomy. Thirty patients who underwent single-incision cholecystectomy were compared to an equal number of patients who underwent three-port cholecystectomy. Both groups were assessed on the basis of operative time, intraoperative complications, postoperative pain, ambulation, hospital stay, and body image at first and third week. Single-incision cholecystectomy had the advantage of less postoperative pain, early ambulation, and better body image as compared to three-port cholecystectomy; the results being statistically significant. There was no statistically significant difference in operative time and hospital stay between the two groups. Single-incision laparoscopic cholecystectomy using conventional instruments is a safe and effective surgery. It gives better cosmetic results, almost scarless surgery, without increasing the cost of surgery.
| S-EPMC4692840 | biostudies-literature
Project description:PURPOSE:Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. METHODS:In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. RESULTS:Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). CONCLUSION:SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.).
| S-EPMC3868679 | biostudies-literature
Project description:Although achieving the critical view of safety (CVS) is useful for avoiding vasculobiliary injury during laparoscopic cholecystectomy (LC), the CVS cannot always be achieved in cases of severe cholecystitis because of technical difficulties. Herein, we focused on segment IV of the liver and its diagonal line (D-line) as a feasible landmark for carrying out difficult LC. The D-line connects the right dorsal and left ventral corners of segment IV and is used as the vectoral landmark, which is where the gallbladder is first dissected to achieve CVS without misidentification. Conversion to subtotal cholecystectomy along the D-line is also feasible when gallbladder wall scarring is severe. We named this procedure the segment IV approach for LC. Sixty-two consecutive difficult LC (including 27 scheduled LC after percutaneous transhepatic gallbladder drainage [PTGBD] and 35 conservatively treated cases of Tokyo Guidelines [TG] grade II cholecystitis) were managed by the segment IV approach. Successful gallbladder extraction along the D-line was achieved in 44 (71%) cases; all of these cases also achieved CVS following total cholecystectomy. The other 18 (29%) cases were converted to subtotal cholecystectomy because gallbladder extraction along the D-line failed as a result of severe cholecystitis with inflammatory adhesion with surrounding structures. Median operative time and intraoperative blood loss were 135 (range, 54-290) min and 10 (range, 0-100) mL, respectively. No intra- or postoperative complications were observed. The segment IV approach is feasible for achieving CVS and for considering subtotal cholecystectomy in difficult LC cases where scarring of the gallbladder wall is present.
| S-EPMC7105843 | biostudies-literature
Project description:Purpose:Postcholecystectomy syndrome (PCS) is characterized by abdominal symptoms following gallbladder removal. However, there is no consensus for the definition or treatment for PCS. The purpose of this study was to define PCS among various symptoms after laparoscopic cholecystectomy, and to identify risk factors affecting PCS. Methods:This study was conducted at Dongguk University Ilsan Hospital and Chung-Ang University Hospital (2012-2013). Outcomes were assessed using European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Symptom cluster for determining PCS was made by factor analysis. Cluster analysis evaluating risk factors of PCS was made by Ward methods and Dentogram. Results:Factor analysis revealed three distinct symptom clusters, those are 'insomnia and financial difficulties (eigenvalue, 1.707; Cronbach ?, 0.190),' 'appetite loss and constipation (eigenvalue, 1.413; Cronbach ?, 0.480),' and 'right upper quadrant (RUQ) pain and diarrhea (eigenvalue, 1.245; Cronbach ?, 0.315).' Among these symptom clusters, the cluster of 'RUQ pain and diarrhea' was determined as PCS. However, we could not find any risk factors between high symptomatic group and low symptomatic group. Conclusion:PCS could consist of RUQ pain and diarrhea. Well-designed prospective trials are needed to determine risk factors of PCS.
| S-EPMC6121167 | biostudies-literature
Project description:BackgroundPatient understanding of surgical procedures is often incomplete at the time they are performed, invalidating consent, and exposing healthcare providers to complaints and claims of failure to inform. Remote consultations, language barriers and patient factors can hinder an effective consent pathway. New approaches are needed to support communication and shared decision-making.MethodsMulti-language digital animations explaining laparoscopic cholecystectomy were introduced at The Royal London Hospital for patients who attended for elective surgery ( www.explainmyprocedure.com/lapchole ). Patients completed questionnaires on the day of their procedure both before and after introduction of the animations. We assessed patient-reported understanding of the procedure, its intended benefits, the possible risks, and alternatives to treatment in 72 consecutive patients, 37 before (no animation group) and after 35 after introducing the animations into the consent pathway (animation group). Patient understanding in the two groups was compared.ResultsThe two groups were well matched in respect of age, sex and whether English was their first spoken language. The proportions of patients who reported they completely understood the procedure, its benefits, risks, and alternatives in the no animation group were 54, 57, 38 and 24% and in the animation group, 91, 91, 74 and 77%, respectively; p < 0.01 for each comparison.ConclusionThe integration of multi-language laparoscopic cholecystectomy video animations into the patient consent pathway was associated with substantial improvement in reported understanding of the procedure, benefits, risks, and alternatives to treatment. This approach can be applied across all surgical disciplines in a standardised manner in an era of accelerated elective work and remote consultations.
| S-EPMC9244138 | biostudies-literature
Project description:A best evidence topic has been constructed using a described protocol. The three-part question addressed was: is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain? Using the reported search, 8083 papers were found. 8 studies were deemed to be suitable to answer the question. The outcomes assessed were post-operative pain differ in single or standard laparoscopic cholecystectomy, all study used VAS (visual analogue scale). The evidence showed no difference in post-operative pain for patients went for single laparoscopic in compared with standard laparoscopic cholecystectomy.
| S-EPMC7895687 | biostudies-literature
Project description:BackgroundLaparoscopic cholecystectomy (LC) is a gold standard treatment of symptomatic gallstone disease. Meanwhile, it is also a challenging procedure demanding excellent expertise for the best outcomes. Many times, difficult laparoscopic cholecystectomy is a nerve-wracking situation for surgeons. It endangers patients by causing potential injury to vital structures. Thus, we aimed to identify predictors for difficult LC.MethodsA retrospective cross-sectional review of surgical records was done. Patients who underwent laparoscopic cholecystectomy on an elective basis from July 2017 to June 2021 were included in the study. We divided our patients into two groups based on operative findings of difficult LC; difficult LC group and non-difficult LC group. We compared patient's demographics, predictors, and perioperative details and analyzed the data.ResultsA total of 338 patients (82 males) with a median age of 47 years were studied. Total difficult LC was found in 52 patients (15.4%). The overall conversion rate was 8.9%. Logistic multivariable regression analysis revealed that; male gender (odds ratio (OR); 0.171, confidence interval (CI),(0.043-0.675), P; 0.012), past history of acute cholecystitis (OR; 0.038, CI; (0.005-0.309), P; 0.002), gall bladder wall thickness (≥4-5 mm) (OR; 0.074, CI; (0.008-0.666), P; 0.020), fibrotic gallbladder (OR; 166.6, CI; (7.946-3492), P; 0.001), and adhesion at Calot's triangle (OR; 0.021, CI (0.001-0.311), P; 0.005) were independent predictors of difficult LC.ConclusionsGender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4-5 mm), fibrotic gallbladder, and adhesion at Calot's triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.
| S-EPMC8591467 | biostudies-literature
Project description:BackgroundLaparoscopic cholecystectomy is still fraught with bile duct injuries (BDI). A number of methods such as intra-operative cholangiography, use of indocyanine green (ICG) with infrared imaging, and the critical view of safety (CVS) have been suggested to ensure safer Laparoscopic cholecystectomy (LC).To these, we add posterior infundibular dissection as the initial operative maneuver during LC. Here, we report specific technical details of this approach developed over 30 years with no bile duct injuries and update our experience in 1402 LC.MethodsIn this manuscript, we present a detailed and illustrated description of a posterior infundibular dissection as the initial approach to laparoscopic cholecystectomy (LC). This technique developed after thirty years of experience with LC and have used it routinely over the past ten years with no bile duct injury.ResultsBetween January of 2010 and December 2019, 1402 Laparoscopic cholecystectomies were performed using the posterior infundibular approach. Operations performed on elective basis constituted 80.3% (1122/1402) and 19.97% were emergent (280/1402). One intra-operative cholangiogram was performed after a posterior sectoral duct was identified. There was one conversion to open cholecystectomy due to bleeding. There were 4 bile leaks that were managed with endoscopic retrograde cholangio-pancreatography (ERCP). There were no bile duct injuries.ConclusionAdopting an initial posterior mobilization of the gallbladder infundibulum lessens the need for medial and cephalad dissection to the node of Lund, allowing for a safer laparoscopic cholecystectomy. In fact the safety of the technique comes from the initial dissection of the lateral border of the infundibulum. The risk of BDI can be reduced to null as was our experience. This approach does not preclude the use of other intra-operative maneuvers or methods.
| S-EPMC8116291 | biostudies-literature
Project description:In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004-2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6-259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.
| S-EPMC6904718 | biostudies-literature
Project description:BackgroundRecent meta-analyses concluded that antibiotic prophylaxis is not warranted in low-risk laparoscopic cholecystectomy. However, most trials in the meta-analyses had a relatively small sample size and were statistically underpowered. In addition, many of the trials mentioned potential cost savings owing to the elimination of prophylactic antibiotics. However, no trial has statistically estimated the cost effectiveness. To evaluate the results of meta-analyses, we conducted a randomized controlled trial on the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy with an adequate sample size.MethodsFrom March 2007 to May 2013, at the Department of Surgery, Kansai Medical University, patients who were scheduled for elective laparoscopic cholecystectomy were randomly assigned to one of two arms: those who were and were not administered prophylactic antibiotics. The primary endpoint was the occurrence of postoperative infections and secondary endpoints were postoperative hospital stay and medical costs.FindingsDuring the study period, 518 patients were assigned to the Antibiotics group and 519 to the No antibiotics group. Occurrences of surgical site infections, distant infections and overall infections were significantly lower in the Antibiotics group than in the No antibiotics group (0.8 vs. 3.7%, p?=?0.001, OR: 0.205 (95%CI: 0.069 to 0.606); 0.4 vs. 3.1%, p?=?0.0004, OR: 0.122 (95%CI: 0.028 to 0.533); 1.2 vs. 6.7%; p<0.0001, OR: 0.162 (95%CI: 0.068 to 0.389), respectively). The postoperative hospital stay was significantly shorter in the Antibiotics group (mean, SD: 3.69±1.56 vs. 4.07±3.00; p?=?0.01) and the postoperative medical costs were significantly lower in the Antibiotics group (mean, SD: $766±341 vs. 832±670; p?=?0.047). Multivariable analysis showed that independent risk factors for postoperative infectious complications were no prophylactic antibiotics (p<0.0001) and age 65 or older (p?=?0.006).ConclusionsPerioperative administration of prophylactic antibiotics should be recommended in laparoscopic cholecystectomy to prevent postoperative infectious complications and to reduce medical costs.Trial registrationUMIN Clinical Trials Registry UMIN000003749.
| S-EPMC4156368 | biostudies-literature