Laparoscopic Cholecystectomy Using 2-mm Instruments

Langenbeck's Archives of Surgery, 2004

Gallbladder disease, often characterized by gallstones and related symptoms, is a prevalent condition that frequently requires surgical intervention. Laparoscopic cholecystectomy (LC) has revolutionized the management of gallbladder disease, offering significant advantages over traditional open cholecystectomy. This abstract provides an overview of the key aspects of LC, encompassing patient selection, surgical techniques, outcomes, and recent advancements. Patient selection is a pivotal factor in achieving successful outcomes in LC. The abstract discusses criteria for selecting appropriate candidates, taking into consideration factors such as the presence of gallstones, severity of symptoms, and patient comorbidities. It underscores the importance of tailored treatment plans and comprehensive preoperative assessment. The surgical techniques employed in LC are detailed to provide a comprehensive understanding of the procedure. The abstract highlights the benefits of laparoscopy, including smaller incisions, reduced postoperative pain, and quicker recovery times. It also discusses the significance of identifying and addressing potential complications during the procedure, such as bile duct injury or bleeding. Clinical outcomes associated with LC are also discussed, focusing on shorter hospital stays, faster return to normal activities, and excellent symptom relief. Potential complications and their management are addressed, emphasizing the importance of surgical expertise in minimizing adverse events. Furthermore, recent advancements in LC, such as the use of enhanced imaging modalities, single-incision laparoscopic cholecystectomy (SILC), and the application of robotics in gallbladder surgery, are highlighted. These innovations have contributed to enhancing the precision and success rates of the procedure while minimizing potential risks. In conclusion, laparoscopic cholecystectomy has become a highly effective and minimally invasive approach to manage gallbladder disease, providing significant benefits for patients in terms of reduced morbidity and improved postoperative recovery. This abstract provides an overview of the key aspects and recent advancements in this field, underlining its potential to enhance the management of gallbladder-related conditions.

JAMA: The Journal of the American Medical Association, 1993

International journal of surgery (London, England), 2014

In an effort to overcome the limitations of single-port laparoscopic cholecystectomy (LC) while preserving the cosmetic benefits of reduced ports cholecystectomy, we have developed a 2-port LC that allows for the full, unrestricted use of 4 laparoscopic instruments. We retrospectively analyzed data of patients who had undergone either 4-port LC or 2-port LC for benign gallbladder diseases between March 2007 and March 2013. Two incisions of 2-port LC were composed of an umbilical incision as the manner of single-port laparoscopic surgery and a 5-mm epigastric incision. These two incisions were utilized for comfortable bimanual manipulation under the liver-elevated vision provided by a liver retractor. During the study period, 766 patients underwent LC; 263 (34.3%) started with 4-port LC, and 503 (65.7%) started with 2-port LC. Of patients started with 2-port LC, 486 patients (96.6%) was ended up with 2-port without open conversion or addition of port(s). The two groups had similar op...

2012

Medicine is an ever changing art and needs to be shared with the progeny. Since the advent of laparoscopy, a new beginning started in the art of surgical craft. Many innovations and technical modifications are on the way for the satisfaction of the patient and the surgeon dealing with minimal access procedures. Laparoscopic cholecystectomy has revolutionized the whole globe and does not need any special mention. At the beginning surgeons would feel comfortable dealing with simple gallbladders but with the increase in expertise and introduction of newer armamentarium, difficult gallbladders are being subsequently dealt with. As of now, laparoscopic cholecystectomy can safely be declared as the gold standard for dealing with any kind of benign gallbladder disorder. However, before going to deal with the inflamed gallbladders; the skill of the surgeon, experience in laparoscopic techniques and thorough knowledge of risk factors are collectively important for a safe outcome. Even in the...

Annals of Saudi medicine

Laparoscopic cholecystectomy (LC) is now a common method of treating symptomatic gallstones, and it is increasingly being requested by the informed general public. Our aim was to evaluate the role of LC for cholelithiasis and to establish its outcome and the effect of gender on the results. Between September 1994 and June 1999, all patients who underwent LC for cholelithiasis were retrospectively reviewed. They were classified as having acute or chronic cholecystitis (AC or CC). There were 791 patients with CC (633 females, 158 males) and 204 patients with AC (124 females, 80 males). Conversion to open cholecystectomy was needed in 0.76% and 11.8% of the patients with CC and AC, respectively (P<0.00). Four percent of the female patients with AC needed conversion as compared to 23.8% in the males (P<0.00). The low conversion rate in CC limited gender comparison. Median operation time in the patients with CC was 53+/-16 minutes as compared to 74.5+/-35.7 minutes in those with AC...

Journal of Medical Sciences

Objectives: To evaluate the results of the first 100 cases of laparoscopic cholecystectomy in symptomatic gall stone disease in our unit. Material and Methods: It was a descriptive study, carried out in Surgical “A” Ward, Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan. This study was conducted from December 2006 to October 2008 including 100 patients who underwent laparoscopic cholecystectomy (LC). All patients with symptomatic gall stones were offered LC, excluding patients with CBD stones. Results: There were 100 patients with symptomatic gallstones, eighty-four (84%) females and Sixteen (16%) males. Eighty percent of the patients had chronic cholecystitis with gall stones. This included 5 patients with mucocele and 2 patients with carcinoma as an incidental finding. Twenty patients had acute cholecystitis. The mean operative time was 45.50 minutes. Mean hospital stay was 2.30 days (range 1.5 – 4 days). Our total conversion rate to open surgery was 4%. Complic...

Rawal Medical Journal, 2011

To evaluate the results of laparoscopic cholecystectomy in symptomatic gall stones disease emphasizing on complications, morbidity and mortality. Patients and Methods This descriptive retrospective study was carried out in department of general surgery Liaquat University Hospital Jamshoro, Sind. Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18 month's period were reviewed. Demographics as well as details of cases of conversion to open operation and complications were noted on a designed performa. Data were analyzed using SPSS10. Results Out of 120 patients, 107 (85%) were females and 18 (15%) were males. The age ranged from 17 to 60 years (Mean 40 years). Six (9.9%) patients had bile leak, 3 (3.9%) developed port site wound infection, 3 (3.9%) developed collection in Morrison pouch and in 3 (3.9%) stones were recovered from epigastric port site wound. There were two cases of bile duct injury and one case of colonic injury. Conversion rate was10% and one patient died in post-operative period. Conclusion Though laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease, our study showed relatively high complication rate. It may be because of learning curve, as it remains a procedure with the potentials for serious complications. Thus we need to have a structured training program involving stepwise progression of training. (Rawal Med J 2011;36:7-9).

Objective: The objective of this study is to determine the per-operative factors responsible for difficulty in performing laparoscopic cholecystectomy and lead to conversion. Study Design: Prospective analysis study. Place and Duration of study: This study was carried out in General Surgery Department of Dow University Hospital Ojha Campus and Civil Hospital Karachi, from Jan 2011 to July 2012. Methodology: This study consisted of one hundred & forty six patients with gallstone disease. All patients had full clinical examination and right hypochondrium was especially examined for assessment of murphy's sign, palpable mass and visceromegaly. Base line and specific investigations were done in all patients especially ultrasound of abdomen as diagnostic modality and for assessment of gallstone disease. Inclusion criteria was that all patients diagnosed as case of gallstone disease. LC procedure was not attempted in patients with history of abdominal surgery, pregnant ladies due to risk of foetal loss, carcinoma of gall bladder acute pancreatitis, obstructive jaundice and unfit patients for general anesthesia. Results: Out of 146 patients included in this study 133 were female (91%) and 13 male (9%); with female to male ratio of 10.2:1. The mean age was 39.21+6.20 years. Per Operative findings were adhesions in calot's triangle 24(16.43%) cases, severe & tight adhesions around gallbladder and calot's triangle 21(14.38%) cases, obscured anatomy in calot's triangle 17(11.64%) cases, intrahepatic gallbladder 11(7.53%) cases, adhesions around gallbladder 26(17.80%) cases, empyema 13(8.90%) cases, mucocele 9(6.16%) and anatomical variation 14(9.58%) cases. We observed out of 21 patients who had Severe & tight adhesions around gallbladder and calot's triangle, lead to difficulty in performing laparoscopic cholecystectomy in 11(52.38%) cases followed by 17 cases of obscured anatomy in calot's triangle and 14 cases anatomical variation also lead to performing difficult laparoscopic cholecystectomy in 6(35.29%) and 5(35.71%) cases respectively. Four (2.73%) cases out of 146 had to be converted to the open cholecystectomy procedure. Conclusions: We conclude our study revealed that various peroperative factors which make the difficult laparoscopic procedure and lead to open cholecystectomy are severe adhesions in calot's triangle, severe & tight adhesions around gallbladder and obscured anatomy in calot's triangle

2018

A novel where the scenery is the city of Peniche, an Atlantic Portuguese port and an ancient enigmatic island, and where the various patrimonies – the legends, the history, the archaeological evidences... – are always present can show us that we can also use the literature to have an excellent contribute to give value and to preserve the memories of the Past. Key-words: Peniche, Morraçal da Ajuda, Roman pottery, amphoras, L. Arvenius Rusticus.