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1

Single-port access in laparoscopic cholecystectomy  

Microsoft Academic Search

Background  Single-port access cholecystectomy is a new laparoscopic procedure using only one, transumbilical-placed port. The method\\u000a has been denominated by some authors as “scarless.” We report one of the initial clinical experiences in Europe with this\\u000a new technique.\\u000a \\u000a \\u000a \\u000a Methods  Fourteen patients underwent laparoscopic cholecystectomy using the ASC TriPort. In all cases, a small transumbilical incision\\u000a was used to insert two 5-mm rigid

Thomas E. Langwieler; Thomas Nimmesgern; Melanie Back

2009-01-01

2

Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy  

Microsoft Academic Search

Introduction  There have been attempts to minimize the invasiveness of laparoscopic cholecystectomy by reducing the size and\\/or the number\\u000a of the operating ports and instruments. These attempts create technical challenges related principally to retraction and triangulation\\u000a necessary to expose the surgical field for a safe surgery. A new technique based on retraction and triangulation with magnetic\\u000a instruments for single port laparoscopic

Guillermo Dominguez; Luis Durand; Julián De Rosa; Eduardo Danguise; Carlos Arozamena; Pedro A. Ferraina

2009-01-01

3

Micro-laparoscopic Cholecystectomy: An Alternative to Single-Port Surgery  

Microsoft Academic Search

Introduction  Recent advances in minimally invasive surgery aimed at diminishing incision size have led to the development of single-port\\u000a surgery (SPS). SPS has an increased level of complexity and requires a higher level of surgical skill compared to traditional\\u000a laparoscopy. We explored micro-laparoscopy as an alternative to routine laparoscopic cholecystectomy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The study is a retrospective review of consecutive elective laparoscopic cholecystectomies

Denise McCormack; Pierre Saldinger; Andrei Cocieru; Suzanne House; Keith Zuccala

2011-01-01

4

Hybrid Single-Port Cholecystectomy in Children  

PubMed Central

Background and Objectives: Multiple single-port or single-incision techniques have been successfully implemented for laparoscopic cholecystectomy in adults and children. These techniques require either a large multichannel port or a larger skin incision to accommodate multiple ports or instruments. Inspired by a first generation single-port instrument, we developed a safe and effective technique for a single-port laparoscopic cholecystectomy with virtually scarless results. Methods: Over a 14-mo period, 20 patients (19 females, 1 male) underwent the hybrid single-port cholecystectomy. A straight 10-mm Storz telescope with inbuilt 6-mm working channel in combination with 2 portless 2.3-mm percutaneous graspers was used. The dissection is carried out with 43-cm bariatric length instruments. The cystic artery and duct are sealed with WECK Hem-o-lok clips or the Harmonic scalpel. Results: Range (mean) age: 7.7 y to 19.5 y (15.5), BMI: 11.6kg/m2 to 42.3kg/m2 (27), operative duration 48 min to 120 min (79), postoperative length of stay: 5 h to 78 h (24). Diagnosis: 13 patients cholecystolithiasis, 7 patients biliary dyskinesia. Conversion to conventional 4-port cholecystectomy was required in 2 patients. No intra- or postoperative complications occurred. Conclusion: The hybrid single-port technique is easy to master. It provides traditional anatomical exposure and allows application of conventional laparoscopic principles.

Ramirez, Jose R.; Magnuson, David K.

2012-01-01

5

Evaluating Systemic Stress Response in Single Port vs. Multi-Port Laparoscopic Cholecystectomy  

Microsoft Academic Search

Background and Aims  Acute-phase proteins and inflammatory cytokines mediate measurable responses to surgical trauma, which are proportional to\\u000a the extent of tissue injury and correlate with post-operative outcome. By comparing systemic stress following multi-port (LC)\\u000a and single-incision laparoscopic cholecystectomy (SILC), we aim to determine whether reduced incision size induces a reduced\\u000a stress response.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Thirty-five consecutive patients were included, 11 underwent SILC

Colleen G. C. McGregor; Mikael H. Sodergren; Alec Aslanyan; Victoria J. Wright; Sanjay Purkayastha; Ara Darzi; Paraskevas Paraskeva

2011-01-01

6

Cosmesis and body image after single-port laparoscopic or conventional laparoscopic cholecystectomy: a multicenter double blinded randomised controlled trial (SPOCC-trial)  

PubMed Central

Background Emerging attempts have been made to reduce operative trauma and improve cosmetic results of laparoscopic cholecystectomy. There is a trend towards minimizing the number of incisions such as natural transluminal endoscopic surgery (NOTES) and single-port laparoscopic cholecystectomy (SPLC). Many retrospective case series propose excellent cosmesis and reduced pain in SPLC. As the latter has been confirmed in a randomized controlled trial, patient's satisfaction on cosmesis is still controversially debated. Methods/Design The SPOCC trial is a prospective, multi-center, double blinded, randomized controlled study comparing SPLC with 4-port conventional laparoscopic cholecystectomy (4PLC) in elective surgery. The hypothesis and primary objective is that patients undergoing SPLC will have a better outcome in cosmesis and body image 12 weeks after surgery. This primary endpoint is assessed using a validated 8-item multiple choice type questionnaire on cosmesis and body image. The secondary endpoint has three entities: the quality of life 12 weeks after surgery assessed by the validated Short-Form-36 Health Survey questionnaire, postoperative pain assessed by a visual analogue scale and the use of analgesics. Operative time, surgeon's experience with SPLC and 4PLC, use of additional ports, conversion to 4PLC or open cholecystectomy, length of stay, costs, time of work as well as intra- and postoperative complications are further aspects of the secondary endpoint. Patients are randomly assigned either to SPLC or to 4PLC. Patients as well as treating physicians, nurses and assessors are blinded until the 7th postoperative day. Sample size calculation performed by estimating a difference of cosmesis of 20% (alpha = 0.05 and beta = 0.90, drop out rate of 10%) resulted in a number of 55 randomized patients per arm. Discussion The SPOCC-trial is a prospective, multi-center, double-blind, randomized controlled study to assess cosmesis and body image after SPLC. Trial registration (clinicaltrial.gov): NCT 01278472

2011-01-01

7

Single-port endo-laparoscopic surgery in combined abdominal procedures.  

PubMed

Single-port endo-laparoscopic surgery has gained support in the surgical community because it is perceived to offer a better postoperative outcome as it requires only a single incision. We write this prospective observational study to ascertain the feasibility and safety of this technique in patients otherwise requiring two operations. Five patients who underwent double procedures with a single-port device were reviewed: Case 1, a transabdominal preperitoneal hernia repair and gastric wedge resection; Case 2, cholecystectomy and diaphragmatic hernia repair; Case 3, oophorectomy and incisional hernia repair; Case 4, anterior resection of the rectum and hepatic segmentectomy; and Case 5, left adrenalectomy and cholecystectomy. Patient demographics, type of port used, operative time, complications and incision length were collected. Mean operative time for the cases ranged from 100 to 315?min. Incision length for the single-port device was 2?cm. In Case 2, an additional 5-mm port was used and an intraoperative complication involving a laceration of the liver occurred during the suturing of the gallbladder fundus. An additional 8-cm lower abdominal incision (Pfannenstiel) was required in Case 4 to complete the colonic anastomosis and for specimen retrieval. Single-port endo-laparoscopic surgery is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that a double procedure creates, and if difficulty arises, another port can always be added to ease the operation. It can also potentially reduce the number of admissions and anesthesia that a patient undergoes. PMID:23879412

Kim, Guowei; Lomanto, Davide; Lawenko, Michael M; Lopez-Gutierrez, Javier; Lee-Ong, Alembert; Iyer, Shridhar Ganpathi; Cheah, Wei Keat; So, Jimmy Bok Yan; Tsang, Charles Bih Shiou; Fong, Yoke Fai

2013-08-01

8

Single port laparoscopic right hemicolectomy for ileocolic intussusception  

PubMed Central

A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

Chen, Jia-Hui; Wu, Jhe-Syun

2013-01-01

9

Laparoscopic single port surgery in children using Triport: our early experience.  

PubMed

Laparoscopy has become the gold standard technique for appendectomy and cholecystectomy. With the emergence of newer laparoscopic instruments which are roticulating and provide 7 degrees of freedom it is now possible to perform these operations through a single umbilical incision rather than the standard 3-4 incisions and thus lead to more desirable cosmetic results and less postoperative pain. The newer reticulating telescopes provide excellent exposure of the operating field and allow the operations to proceed routinely. Recently, ports [Triports (Olympus surgery)/SILS ports] especially designed for single incision laparoscopic surgery (SILS) have been developed. We herein describe our experience with laparoscopic single port appendectomies and cholecystectomies in children using the Triport. This is a retrospective cohort study of children who underwent single incision laparoscopic surgery between May 2009 and August 2010 at Texas Children's Hospital and Ben Taub General Hospital in Houston Texas by a single surgeon. Charts were reviewed for demographics, type of procedure, operative time, early or late complications, outcome and cosmetic results. Fifty-four patients underwent SILS. A total of 50 appendectomies (early or perforated) and 4 cholecystectomies were performed using this new minimally invasive approach. The average operative time for SILS/LESS appendectomy was 54 min with a range between 25 and 205 min, while operative time for SILS cholecystectomy was 156 min with a range of 75-196 min. Only small percentage (4%) of appendectomies (mostly complicated) were converted to standard laparoscopy, but none were converted to open procedure. All patients were followed up in the clinic after 3-4 weeks. No complications were noted and all patients had excellent cosmetic results. Parents were extremely satisfied with the cosmetic results. SILS/LESS is a safe, minimally invasive approach for appendectomy and cholecystectomy in children. This new approach is performed in an acceptable operative time with good outcomes and great cosmetic result. PMID:21461884

de Armas, Ismael A Salas; Garcia, Isabella; Pimpalwar, Ashwin

2011-04-03

10

Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease  

PubMed Central

Background. Single Port Laparoscopic Surgery (SPLS) is being increasingly employed in colorectal surgery for benign and malignant diseases. The particular role for SPLS in inflammatory bowel disease (IBD) has not been determined yet. In this review article we summarize technical aspects and short term results of SPLS resections in patients with Crohn's disease or ulcerative colitis. Methods. A systematic review of the literature until January 2012 was performed. Publications were assessed for operative techniques, equipment, surgical results, hospital stay, and readmissions. Results. 34 articles, published between 2010 and 2012, were identified reporting on 301 patients with IBD that underwent surgical treatment in SPLS technique. Surgical procedures included ileocolic resections, sigmoid resections, colectomies with end ileostomy or ileorectal anastomosis, and restorative proctocolectomies with ileum-pouch reconstruction. There was a wide variety in the surgical technique and the employed equipment. The overall complication profile was similar to reports on standard laparoscopic surgery in IBD. Conclusions. In experienced hands, single port laparoscopic surgery appears to be feasible and safe for the surgical treatment of selected patients with IBD. However, evidence from prospective randomized trials is required in order to clarify whether there is a further benefit apart from the avoidance of additional trocar incisions.

Rijcken, Emile; Mennigen, Rudolf; Senninger, Norbert; Bruewer, Matthias

2012-01-01

11

Single port laparoscopic appendectomy: are we pursuing real advantages?  

PubMed Central

Single port appendectomy, due to its cosmetic appeal and to a technique similar to classic laparoscopic appendectomy, is provoking an increasing number of publications and case series to explore its feasibility and effective improvements for patients with acute appendicitis. The margins for improvement are not so large, as laparoscopic appendectomy is, after 20 years from its beginning, still debated. A literature search has been accomplished to investigate the outcomes of the operation. 23 case series or retrospective comparisons with classic laparoscopy have been found. The numbers and low quality of the published data do not permit to draw evidence based conclusions. Still, trends seem to evidence an increase in complications especially in complicated appendicitis, which suggests caution in its dissemination outside clinical trials.

2011-01-01

12

Single Incision Laparoscopic Total Gastrectomy and D2 Lymph Node Dissection for Gastric Cancer Using a Four-Access Single Port: The First Experience  

PubMed Central

Single incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have been developed to reduce the invasiveness of laparoscopic surgery. SILS has been frequently applied in various clinical settings, such as cholecystectomy, colectomy, and sleeve gastrectomy. So far, there have been four reports on single incision laparoscopic distal gastrectomy and one report on single incision laparoscopic total gastrectomy with D1 lymph node dissection for gastric cancer. In this report, we present our single incision laparoscopic total gastrectomy with D2 lymph node dissection technique using a four-hole single port (OctoPort) in a patient with gastric cancer.

Ozveri, Emel; Gok, Hakan; Ozben, Volkan

2013-01-01

13

Laparoscopic Cholecystectomy in Cirrhotics  

PubMed Central

Background and Objectives: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure. Methods: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified. Results: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed. Conclusions: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate.

2012-01-01

14

Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery  

PubMed Central

Purpose Conventional laparoscopic appendectomy is performed using three ports, and single-port appendectomy is an attractive alternative in order to improve cosmesis. The aim of this study was to compare pain after transumbilical single-port laparoscopic appendectomy (SA) with pain after conventional three-port laparoscopic appendectomy (TA). Methods From April to September 2011, 50 consecutive patients underwent laparoscopic appendectomy for simple appendicitis without gangrene or perforation. Patients who had undergone appendectomy with a drainage procedure were excluded. The type of surgery was chosen based on patient preference after written informed consent was obtained. The primary endpoint was postoperative pain evaluated by the visual analogue scale score and postoperative analgesic use. Operative time, recovery of bowel function, and length of hospital stay were secondary outcome measures. Results SA using a SILS port (Covidien) was performed in 17 patients. The other 33 patients underwent TA. Pain scores in the 24 hours after surgery were higher in patients who underwent SA (P = 0.009). The change in postoperative pain score over time was significantly different between the two groups (P = 0.021). SA patients received more total doses of analgesics (nonsteroidal anti-inflammatory drugs) in the 24 hours following surgery, but the difference was not statistically significant. The median operative time was longer for SA (P < 0.001). Conclusion Laparoscopic surgeons should be concerned about longer operation times and higher immediate postoperative pain scores in patients who undergo SA.

Kim, Hyung Ook; Lee, Sung Ryol; Son, Byung Ho; Park, Yong Lai; Shin, Jun Ho; Kim, Hungdai; Han, Won Kon

2012-01-01

15

Laparoscopic Anterograde Cholecystectomy in Acute Cholecystitis  

PubMed Central

In the laparoscopic surgery of acute cholecystitis, no identification of anatomic structures in Calot triangle prevents the retrograde disection. Therefore, the anterograde disection of gall bladder, which we often use in open cholecystectomy, was applied as an alternative method in laparoscopic cholecystectomy in our 2 cases. Through this method, the safety of the attempt was increased and the patients were not deprived of the comfort of laparoscopic cholecystectomy. Keywords Laparoscopic anterograde cholecystectomy; Acute cholecystitis; Gall bladder

Engin, Omer; Yildirim, Mehmet; Cengiz, Fevzi; Ilhan, Enver

2009-01-01

16

CURRENT TRENDS IN LAPAROSCOPIC CHOLECYSTECTOMY  

PubMed Central

Gallstone disease is still a major health problem worldwide. Open cholecystectomy was the standard treatment for symptomatic gallstones for more than 100 years. The introduction of laparoscopic cholecystectomy in the late 1980s has led to dramatic changes in the management of gallstone disease. The aim of this review is to equip the general practitioner with the answers to questions a patient may ask about the current management of gallstones.

Al-Mulhim, Abdulmohsen A.

1997-01-01

17

Laparoscopic and Open Cholecystectomy in Surgical Training  

Microsoft Academic Search

Background: Open cholecystectomy (OC) may still be necessary in surgical training to perform safe conversions of laparoscopic cholecystectomy (LC). Our aim was to study the outcome of LCs and OCs performed by surgical trainees. Methods: All consecutive cholecystectomies (1,581 LCs and 984 OCs) were retrospectively analyzed from 1995 until 2008. Operative complications were compared between the cholecystectomies performed by 20

Satu Suuronen; Anu Koski; Pia Nordstrom; Pekka Miettinen; Hannu Paajanen

2010-01-01

18

Imaging of complications of laparoscopic cholecystectomy  

Microsoft Academic Search

Laparoscopic cholecystectomy has gained widespread acceptance for treatment of cholelithiasis. Because radiologists have aprimary role in recognizing and treating complications of this surgical technique, we reviewed the clinical records and imaging studies of 29 patients with complications after laparoscopic cholecystectomy. Complications included bile duct injuries (15 cases), retained common bile duct stones (seven cases), cystic duct stump leak (four cases),

Ellen M. Ward; Andrew J. LeRoy; Claire E. Bender; John H. Donohue; Rollin W. Hughes

1993-01-01

19

Cicatrical Cecal Volvulus Following Laparoscopic Cholecystectomy  

PubMed Central

Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic biliary disease. There is currently no agreement on the management of spilled gallstones, which commonly occurs during laparoscopic cholecystectomy and may produce significant morbidity. We present a case of spilled gallstones causing cicatrical cecal volvulus and also provide a review of pertinent literature.

Morris, Michael W.; Barker, Andrea K.; Harrison, James M.; Anderson, Andrew J.

2013-01-01

20

Granulomatous Peritonitis After Laparoscopic Cholecystectomy  

PubMed Central

Background: Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cell-mediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique. Methods: We report a case of sterile granulomatous peritonitis in an 80-y-old female after a laparoscopic cholecystectomy. Management was conservative, and no relapse was observed after over 1-y of follow-up. Discussion: We propose that peritoneal exposure to bile acids during the laparoscopic removal of the gallbladder was the trigger of granulomatous peritonitis in this patient. Severe complications, such as peritoneal adhesions, intestinal obstruction, and fistula formation, were observed, but no fatalities were reported. Conclusion: We should be aware of this rare cause of peritonitis in the surgical setting.

Remotti, Daniele; Galluzzo, Michele; Gasbarrone, Laura

2012-01-01

21

Single-port cholecystectomy in a patient with situs inversus totalis presenting with cholelithiasis: a case report  

PubMed Central

Introduction Situs inversus totalis (mirror image organs) is a rare condition and may affect the intra-abdominal viscera as well as the intrathoracic organs. Cholelithiasis is not more common in these conditions, but the diagnosis may be more difficult. Case presentation We present the case of a 59-year-old African woman with gallstones and situs inversus totalis. A single-port cholecystectomy was performed using a single trocar access device (SITRACC). Conclusions The procedure was uneventful, showing that this approach may be an option for this kind of surgery even in patients with situs inversus totalis.

2012-01-01

22

Cholelithoptysis: An unusual complication of laparoscopic cholecystectomy  

Microsoft Academic Search

Laparoscopic cholecystectomy is emerging as a preferred surgical method in the treatment of cholecystitis. Decreased morbidity and mortality rates make this an attractive altenative to conventional cholecystectomy. Recently, specific complications including bile duct transection, biloma formation, and liver lacerations have been reported. We report here, however, an unusual case of intraoperative spillage of stones into the introperitoneal cavity. Subsequent erosion

Jill Thompson; Etta Pisano; David Warshauer

1995-01-01

23

Single-port laparoscopic adrenalectomy for a right-sided aldosterone-producing adenoma: a case report  

PubMed Central

Introduction Single-port laparoscopic adrenalectomy is one of the most interesting surgical advances. Here, we evaluate the safety and feasibility of single-port laparoscopic adrenalectomy as treatment for a right-sided aldosterone-producing adenoma. Case presentation A 39-year-old Japanese woman presented with hypertension and hypokalemia. Abdominal computed tomography and an endocrinological workup revealed a 19mm right adrenal tumor with primary aldosteronism. Our patient was informed of the details of the surgical procedure and our efforts to reduce the number of incisions needed - ideally, to a single incision - when removing her adrenal gland. A single-port laparoscopic adrenalectomy was attempted. A multichannel port was inserted through a 2.5cm umbilical incision. A 5mm flexible laparoscope, articulating laparoscopic dissector and tissue sealing device were the primary tools used in the operation. The right liver lobe was evaluated using a percutaneous instrument, providing good visualization of the operative field surrounding her right adrenal gland. The single-port laparoscopic adrenalectomy was successfully completed without any intraoperative complications. The operating time was 76 minutes, and her blood loss was 5mL. Oral intake was resumed on the first postoperative day, and the length of her hospital stay was three days. Her postoperative course was uneventful with no morbidity within one month of follow-up, and our patient had excellent cosmetic results. Conclusions Single-port laparoscopic adrenalectomy is a safe and feasible procedure for patients with a right-sided adrenal tumor when performed by a surgeon experienced in laparoscopic and adrenal surgery. However, more surgical experience using this technique is required to confirm our initial impressions.

2012-01-01

24

Technical approaches to single port/incision laparoscopic appendicectomy: a literature review  

PubMed Central

INTRODUCTION Single port/incision laparoscopic surgery (SPILS) is a modern advancement toward stealth surgery. Despite the paucity of high-quality scientific studies assessing its effectiveness, this procedure is being used increasingly. This review aims to describe commonly used techniques for SPILS appendicectomies (SPILA), to summarise complication rates in the literature and to provide discussion on indications and implementation. METHODS All available databases including the Cochrane Central Register of Controlled Trials, MEDLINE® and Embase™ were searched in February 2011 and cross-referenced for available English literature describing SPILA in patients of any age. RESULTS Three broad technical approaches are described: procedures using laparoscopic instruments through a single skin incision in the abdominal wall, regardless of the number of fascial incisions, with or without the additional use of percutaneous sutures or wires to ‘assist’ the operation, and hybrid procedures, in which the appendix is exteriorised using a single incision laparoscopically assisted operation but subsequently divided using a conventional ‘open’ appendicectomy technique. Complication rates seem to be highest in SPILA procedures unassisted by sutures or wires. CONCLUSIONS Future research assessing the efficacy of single incision laparoscopic procedures should consider variation in technique as a possible factor affecting outcome.

Rehman, H; Ahmed, I

2011-01-01

25

Single port Billroth I gastrectomy  

PubMed Central

Introduction: Experience has allowed increasingly complex procedures to be undertaken by single port surgery. We describe a technique for single port Billroth I gastrectomy with a hand-sewn intracorporeal anastomosis in the resection of a benign tumour diagnosed incidentally on a background of cholelithiasis. Materials and Methods: Single port Billroth I gastrectomy and cholecystectomy was performed using a transumbilical quadport. Flexible tipped camera and straight conventional instruments were used throughout the procedure. The stomach was mobilised including a limited lymph node dissection and resection margins in the proximal antrum and duodenum were divided with a flexible tipped laparoscopic stapler. The lesser curve was reconstructed and an intracorporal hand sewn two layer end-to-end anastomosis was performed using unidirectional barbed sutures. Intraoperative endoscopy confirmed the anastomosis to be patent without leak. Results: Enteral feed was started on the day of surgery, increasing to a full diet by day 6. Analgesic requirements were a patient-controlled analgesia morphine pump for 4 postoperative days and paracetamol for 6 days. There were no postoperative complications and the patient was discharged on the eighth day. Histology confirmed gastric submucosal lipoma. Discussion: As technology improves more complex procedures are possible by single port laparoscopic surgery. In this case, flexible tipped cameras and unidirectional barbed sutures have facilitated an intracorporal hand-sewn two layer end-to-end anastomosis. Experience will allow such techniques to become mainstream.

Huddy, Jeremy R; Jamal, Karim; Soon, Yuen

2013-01-01

26

Gallstone ileus after laparoscopic cholecystectomy  

PubMed Central

Gallstone ileus represents a rare complication (0,3-0,5%) of a serious, but common disease-gallstones, which affect around 10% of the population in the USA and Western Europe. Associated diseases (usually severe), elderly patients, delayed diagnosis and therapy due to late presentation to the hospital, account for the morbidity and mortality rates described in literature. We present the case of a patient with partial colon obstruction due to a large gallstone that was “lost” during an emergency laparoscopic cholecystectomy. The calculus eroded the intestinal wall, partially occluding the lumen, triggering recurrent Kerwsky-like, subocclusive episodes. The intraperitoneal abscess has spontaneously drained through the subhepatic drain and once the tube has been removed, a persistent intermittent fistula became obvious.

Ivanov, I; Beuran, M; Venter, MD; Iftimie-Nastase, I; Smarandache, R; Popescu, B; Bostina, R

2012-01-01

27

Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre  

PubMed Central

BACKGROUND: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive – from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. MATERIALS AND METHODS: Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis. RESULTS: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8–25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. CONCLUSION: Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The advantage of minimal instrumentation and avoidance of intracorporeal knotting makes it a feasible technique for a secondary care centre.

Kumar, Ameet; Ramakrishnan, T S

2013-01-01

28

Single-port laparoscopic repair of an epigastric hernia using an epidural needle  

PubMed Central

INTRODUCTION Epigastric hernia is a rare form of ventral hernia, occurring along the linea alba anywhere from the xiphoid process to the umbilicus. PRESENTATION OF CASE We present the case of a 19-month-old boy with an epigastric hernia who underwent a single-port laparoscopic repair using an epidural needle. A nonabsorbable suture was threaded through an epidural needle, with one end of the suture threaded back through the needle tip to make a loop. The loop-shaped suture was left in the abdominal cavity through the rectus muscle at the site of the defect. Another suture was inserted into the looped suture through the opposite rectus muscle. The loop was pulled taut and the defect was closed by tying the suture extracorporeally with a subcutaneous knot. DISCUSSION In epigastric hernia, the surgical technique involves overlapping muscle layers, and currently laparoscopic surgery is introduced to repair the hernia defect. Laparoscopy is a minimally invasive method of repairing epigastric hernias. CONCLUSION The epidural needle proved a simple and cosmetically acceptable device with which to close the epigastric hernia defect.

Tatekawa, Yukihiro; Yamanaka, Hiroaki; Hasegawa, Toshimichi

2012-01-01

29

Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer.  

PubMed

Our objective was to report of our first experience with transanal total mesorectal excision (TME) of rectal cancer using single-port equipment, a pure natural orifice transluminal endoscopic surgery (NOTES) procedure, and to discuss the advantages and disadvantages of the technique. A patient with rectal cancer was selected according to preoperative evaluation criteria. Purse-string sutures were placed into the rectum distal to the tumor using the procedure of prolapse and hemorrhoids (PPH) anoscope. A full-thickness incision of the rectal wall was made circumferentially below the purse string and a three-channel cannula was inserted. The artificial orifice was insufflated. The entire mesorectum was dissected upward according to the principles of TME. Pneumoperitoneum was created by opening the rectouterine pouch. The sigmoid colon and its mesentery were dissected, and the inferior mesenteric vessels were ligated and divided. After dissection of a sufficient length of sigmoid colon, the PPH anoscope and the three-channel cannula were removed. The rectum and sigmoid colon were brought out through the anus. The tumor was resected. After removal of the specimens, a stapled end-to-end anastomosis was fashioned between the rectum and the sigmoid colon. Operative time was 300 min. The mesorectum was completely removed with negative distal and circumferential margin. The final pathological stage was pT3N1M0, with one positive lymph node (1/12). The patient recovered uneventfully after surgery. Pure-NOTES performed as transanal single-port laparoscopic TME for rectal cancer appears to be feasible and safe. PMID:22936590

Zhang, H; Zhang, Y-S; Jin, X-W; Li, M-Z; Fan, J-S; Yang, Z-H

2012-08-31

30

The learning curve for laparoscopic cholecystectomy  

Microsoft Academic Search

Background: The use of laparoscopic surgical procedures without previous training has grown rapidly. At the same time, there have been allegations of increased complications among less experienced surgeons.Methods: Using multivariate regression analyses, we evaluated the relationship between bile duct injury rate and experience with laparoscopic cholecystectomy for surgeons in the Southern Surgeons Club.Results: Fifty-five surgeons performed 8,839 procedures. Fifteen bile

Michael J Moore; Charles L Bennett

1995-01-01

31

The adverse hemodynamic effects of laparoscopic cholecystectomy  

Microsoft Academic Search

Recent studies suggest that significant physiologic derangements can occur during laparoscopic surgery. Eighteen patients admitted for laparoscopic cholecystectomy were studied. The mean age was 46.7 (range 19–78). A standard anesthetic technique, reverse Trendelenburg positioning, and an abdominal insufflation pressure of 15 mmHg with CO2 were used with all subjects. Central venous pressure (CVP) and arterial pressures were measured invasively. Stroke

J. G. McLaughlin; D. E. Scheeres; R. J. Dean; B. W. Bonnell

1995-01-01

32

Difficult Cholecystectomies: Validity of the Laparoscopic Approach  

PubMed Central

Objectives: The aim of this work was to determine the outcome of “difficult cholecystectomy” caused by acute cholecystitis or cirrhosis, in relation to the number of conversions, principal biliary duct injuries, the length of the operation, and of postoperative hospitalization. Methods: From 1998 through 2000, 51 patients, 38 females and 13 males, underwent cholecystectomy for acute cholecystitis and cholecystitis associated with liver cirrhosis; the average age was 58.8 years (range, 24 to 86 years). No preoperative selection was made for video laparoscopic treatment. An open laparoscopy was performed in all cases. Results: All interventions were completed by video laparoscopy. No injury of the major bile ducts occurred in the 51 cases. The average time of operation was 110 minutes. The average length of hospitalization was 3 days. Conclusion: This study demonstrates that the results after “difficult laparoscopic cholecystectomy” are comparable to those after “open cholecystectomy.” Difficult cholecystectomy executed with video laparoscopic methodology is safe and effective if performed with appropriate equipment and by experienced surgeons.

Ambrosi, Antonio; Lauro, Giuseppe Di; Fersini, Alberto; Valentino, Tiziano Pio

2003-01-01

33

Laparoscopic cholecystectomy: the first 155 patients.  

PubMed Central

Laparoscopic cholecystectomy has been attempted in 155 patients. Eight patients required conversion to open cholecystectomy (5%): three owing to lack of clear anatomical detail, two procedures were abandoned because of instrument failure, two had a dilated common bile duct on cholangiography, and one owing to a very adherent mucocele of the gallbladder. Cholangiography was performed selectively; successfully completed in 45 (22% of all patients). Common bile duct stones were found in two patients. All patients were drained, with two bile leaks, one requiring a laparotomy. There was one ductal injury. Most patients (85%) were discharged within 48 h. This initial experience suggests laparoscopic cholecystectomy is the procedure of choice for most patients with symptomatic cholelithiasis.

Rees, B. I.; Williams, H. R.

1992-01-01

34

[Postoperative analgesia by auriculotherapy during laparoscopic cholecystectomy].  

PubMed

Auriculotherapy based on traditional Chinese cartography can be used for pain relief after laparoscopic cholecystectomy. It consists of palpating and pricking some well defined ear points corresponding to the surgical site. Relief was quickly obtained and compares favourably with minor parenteral analgesics. PMID:9033824

Lequang, T; Badaoui, R; Riboulot, M; Verhaeghe, P; Ossart, M

1996-01-01

35

Imaging of the complications of laparoscopic cholecystectomy  

Microsoft Academic Search

Laparoscopic cholecystectomy has, in recent years, emerged as the gold standard therapeutic option for the management of uncomplicated symptomatic cholelithiasis. Each year, up to 700,000 of these procedures are performed in the United States alone. While the relative rate of post-procedural complications is low, the popularity of this method of gallbladder removal is such that this entity is not uncommonly

Derek Lohan; Sinead Walsh; Raymond McLoughlin; Joseph Murphy

2005-01-01

36

Single-Port Transumbilical Laparoscopic Appendectomy: A Preliminary Multicentric Comparative Study in 87 Patients with Acute Appendicitis  

PubMed Central

Introduction. Laparoscopic appendectomy (LA) has been performed in many approaches such as open, laparoscopic and recently Single Port Access (SPAA). In order to elucidate its potential advantages, we compared the two laparoscopic approaches. Methods. 87 patients were included in a multicentric study for suspected appendicitis in order to perform (SPAA) appendectomy or laparoscopic appendectomy (LA). All outcomes, including blood loss, operative time, complications, and length of stay and pain were recorded prospectively. Results. There were 46 patients in the SPAA group and 41 in the LAG with a mean operative time of 40,4 minutes in the SPAA group and 35,0 minutes in the LA group. Only one patient was converted to an open approach. We described only 2 complications. Pain was graded 2,8 in the SPAA group and 2,9 in the LA group, according to the AVS after 24 hours. Patients in the SPAA Group were more satisfied (7,5 versus 6,9) (P < 0.05). Same results were found for the cosmetic result (8,6 versus 7,4) (P < 0.05). Conclusion. Using the single port approach feasible and safe. The true benefit of the technique should be assessed by new randomised controlled trials.

Vilallonga, Ramon; Barbaros, Umut; Nada, Ahmed; Sumer, Aziz; Demirel, Tugrul; Fort, Jose Manuel; Gonzalez, Oscar; Armengol, Manuel

2012-01-01

37

Laparoscopic cholecystectomy using 2-mm instruments.  

PubMed

Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used. Laparoscopic cholecystectomy using 2-mm instruments was performed in a consecutive series of 14 patients with symptomatic gallstones. The procedure was completed in 12 cases, with conversion to open surgery in two cases. Intraoperative cholangiography was always performed. The postoperative course was always uneventful. The cosmetic effect was highly satisfactory. The procedure using 2-mm instruments could be indicated in selected patients with uncomplicated gallstone disease. PMID:9820716

Uranüs, S; Peng, Z; Kronberger, L; Pfeifer, J; Salehi, B

1998-10-01

38

A tactile sensor for laparoscopic cholecystectomy.  

PubMed

During laparoscopic surgery, surgeons observe the three-dimensional abdominal cavity on a two-dimensional TV monitor, which is a limitation. Another limitation is that surgeons are unable to estimate the softness of organs or tissues during laparoscopic surgery as they are only allowed to use instruments which touch objects and direct palpation is not permitted during the procedure. The tactile sensor which we used displays the object softness immediately as a digital score, which can then be superimposed on a TV monitor as a graph. With the tactile sensor, we were able to ascertain the presence of a gallstone in the gallbladder or cholecystic duct during laparoscopic cholecystectomy and also able to discriminate between a stone and an air bubble during intraoperative cholangiography. We were convinced that the tactile sensor would be useful in laparoscopic surgery, which does not permit surgeons to palpate objects with human fingers. PMID:9294278

Matsumoto, S; Ooshima, R; Kobayashi, K; Kawabe, N; Shiraishi, T; Mizuno, Y; Suzuki, H; Umemoto, S

1997-09-01

39

[Intraoperative digital cholangiography during laparoscopic cholecystectomy interventions].  

PubMed

In the last years, laparoscopic cholecystectomy has become the method of choice in the surgical treatment of gallbladder stones. Recently, the same laparoscopic approach has been used to remove choledochus stones. This surgical procedure needs the accurate intraoperative study of the biliary tree with diagnostic imaging modalities to better define the anatomy of the biliary ducts and the possible presence of choledochus stones. To this purpose, transcutaneous and endolaparoscopic US with dedicated probes and intraoperative cholangiography can be performed. In this study, we performed 30 laparoscopic cholecystectomies during which all the patients were submitted to intraoperative cholangiography with a digital fluoroscopic unit. The maneuvers for catheter insertion in the cystic duct and the examination as a whole took 3 to 5 minutes. Intraoperative cholangiography demonstrated choledochus stones in 3 patients, while preoperative US detected them in 2 patients only. In 8 cases the dynamic study, carried out with digital image acquisition, allowed to refer the biliary duct filling defects to artifacts caused by the presence of air bubbles. In conclusion, intraoperative cholangiography, also during endolaparoscopic cholecystectomy, plays a major role in the surgical assessment of the biliary tree. When the procedure was performed with a digital fluoroscopic unit, its diagnostic accuracy was higher and the images on the TV monitor were better visualized. PMID:7938729

Di Girolamo, M; Pavone, P; Lomanto, D; Carlei, F; Fiocca, F; Nardovino, M; Laghi, A; Lezoche, E; Speranza, V

1994-09-01

40

Response of serum cytokines in patients undergoing laparoscopic cholecystectomy  

Microsoft Academic Search

The clinical observation that a laparoscopic cholecystectomy is a minimally invasive operation has not been demonstrated on a biochemical basis. Interleukin-6, a known endogenous pyrogen and hepatocyte-stimulating protein, correlates with the significance of surgical trauma. Utilizing the IL-6 immunoassay, we studied this biochemical parameter of trauma to compare its response in laparoscopic vs open cholecystectomy. Sixteen patients who underwent only

J. M. Cho; A. J. LaPorta; J. R. Clark; M. J. Schofield; S. L. Hammond; P. L. Mallory II

1994-01-01

41

Laparoscopic Cholecystectomy Conversion Rates Two Decades Later  

PubMed Central

Background and Objectives: Now nearly 2 decades into the laparoscopic era, nationwide laparoscopic cholecystectomy conversion rates remain around 5% to 10%. We analyzed patient- and surgeon-specific factors that may impact the decision to convert to open. Methods: We retrospectively analyzed 2205 LCs performed at a large tertiary community hospital over a 52-month period (May 2004 through October 2008). Results: The overall conversion rate was 4.9%. The most common reason for conversion was adhesions, and the majority of these patients had prior abdominal surgery. Males and patients >50 years old had a significantly higher likelihood of open conversion. The conversion rate of high-volume surgeons (?100 total cases) in comparison to low-volume surgeons (40 to 99 total cases) was significantly lower. Conversion rates were lower among surgeons with fellowship training and those who completed residency training after 1990. Interestingly, the percentage of conversions due to technical difficulty was lower among those with fellowship training but higher among those who completed training after 1990. Conclusion: Conversion occurred in ?5% of all laparoscopic cholecystectomies. Males, patients >50 years old, and cases performed by low-volume surgeons had a higher likelihood of conversion. Other surgeon-specific factors did not have a significant impact on conversion rate.

Sakpal, Sujit Vijay; Bindra, Supreet Singh

2010-01-01

42

[Laparoscopic cholecystectomy: analysis of 1122 operations].  

PubMed

The results of 1122 laparoscopic cholecystectomies have been analyzed which were performed within a two year period of time. In 1097 (97.8%) cases the authors managed to carry out the laparoscopic procedure, however in 25 patients (2.2%) the operation had to be converted to an open surgery. There was no hospital mortality, however 1 patient died at home due to pulmonary embolism. (Mortality: 0.09%) According to their survey 758 patients exhibited concurrent medical risk factors and 413 previous abdominal operations increased the "surgical" risk of laparoscopic procedures. 27 early and 46 late postoperative complications have been observed. In 3 instances (0.26%) bile duct injury occurred and in 5 cases (0.44%) reoperations had to be carried out secondary to postoperative complications. Forty patients (3.6%) have had recognized common bile duct stones, these were removed, in part preoperatively (28pts), in part postoperatively (11pts) by endoscopic sphincterotomy (EST). In one case a laparoscopic retrieval of common bile duct stone was accomplished via the dilated cystic duct. 47% of their patients left the hospital on the first day and 78% of them were discharged within 2 days. PMID:8065740

Baltás, B; Bajusz, H; Bende, J; Vattay, P; Lázár, G; Vangel, R; Onodi, J; Kiss, Z F; Takács, T

1994-07-24

43

Technical Refinements in Single-Port Laparoscopic Surgery of Inguinal Hernia in Infants and Children  

PubMed Central

The techniques of minimal access surgery for pediatric inguinal hernia are numerous and they continue to evolve, with a trend toward increasing use of extracorporeal knotting and decreasing use of working ports and endoscopic instruments. Single-port endoscopic-assisted percutaneous extraperitoneal closure seems to be the ultimate attainment, and numerous techniques have mushroomed in the past decade. This article comprehensively reviews and compares the various single-port techniques. These techniques mainly vary in their approaches to the hernia defect with different devices, which are designed to pass a suture to enclose the orifice of the defect. However, most of these emerging techniques fail to entirely enclose the hernia defect and have the potential to lead to higher incidence of hernia recurrence. Accompanying preperitoneal hydrodissection and keeping identical subcutaneous path for introducing and withdrawing the suture, the suture could tautly enclose the hernia defect without upper subcutaneous tissues and a lower peritoneal gap, and a trend towards achieving a near-zero recurrence rate.

Chang, Yu-Tang

2010-01-01

44

Single port laparoscopic colorectal surgery in debilitated patients and in the urgent setting.  

PubMed

Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established. PMID:22971632

Moftah, M; Sehgal, R; Cahill, R A

2012-09-01

45

Acalculous gallbladder disease: the outcomes of treatment by laparoscopic cholecystectomy  

PubMed Central

INTRODUCTION The treatment of symptomatic patients with the presence of gallstones is well established, with laparoscopic cholecystectomy being the treatment of choice for symptomatic cholelithiasis. The results of surgery in symptomatic patients without gallstones are highly variable. These patients are often referred to as having acalculous gallbladder disease and represent between 5% and 30% of laparoscopic cholecystectomies performed annually. We retrospectively reviewed the outcomes of patients who underwent laparoscopic cholecystectomy for acalculous gallbladder disease in our institution. PATIENTS AND METHODS We retrospectively analysed the period from February 2005 to January 2006 where 20 laparoscopic cholecystectomies had been performed specifically for a preoperative diagnosis of acalculous gallbladder disease. The histology of all laparoscopic cholecystectomies performed during this year was analysed and it was found that a further 46 patients had histological specimens that demonstrated the absence of gallstones in the presence of an intact gallbladder specimen. These patients were therefore included in the study group for acalculous gallbladder disease. All patients were sent a questionnaire comparing their state of health before and after surgery. RESULTS After laparoscopic cholecystectomy, 66% of patients were completely pain free. The remainder, however, experienced infrequent, moderate pain with occasional pain on eating. Following surgery, all patients were able to conduct their activities of daily living without any limitation. CONCLUSIONS We therefore conclude that laparoscopic surgery for patients with acalculous gallbladder disease is effective in symptom control and allowing patients to return to their normal lifestyle.

Ahmed, M; Diggory, R

2011-01-01

46

Safe laparoscopic cholecystectomy in a community setting, N=762  

Microsoft Academic Search

Laparoscopic cholecystectomy (LC) can be introduced into a community with morbidity and mortality rates equal to that of open cholecystectomy. The entire general surgical community of Greensboro, NC, learned the technique of LC on animal models prior to offering this innovation to the community. Over the ensuing 12 months, they served as surgeons or assistant surgeons to each other on

Matt Martin; Murray Abrams; Roy Arkin; Pat Ballen; Steve Blievernicht; William Bowman; Tim Davis; Robert Farley; Ben Hoxworth; Haywood Ingram; Anita Lindsey; Mike Leone; David Newman; Thomas Price; Chris Streck; William Weatherly; Peter Young

1993-01-01

47

Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones  

Microsoft Academic Search

Background\\/Aims: The management of patients with silent or asymptomatic gallstones remains controversial. The objective of this study is to determine the complications of laparoscopic cholecystectomy performed to treat patients under 50 years of age with asymptomatic gallstones. Method: 207 patients, 13–49 years of age with asymptomatic gallstones, were subjected to laparoscopic cholecystectomy. There were 161 (78%) women and 46 (22%)

Júlio C. U. Coelho; Alvo O. Vizzoto Jr.; Paolo R. O. Salvalaggio; André R. D. Tolazzi

2000-01-01

48

Coincidental finding of hepatic carcinoid micrometastases during routine laparoscopic cholecystectomy.  

PubMed

A case of a coincidental finding of hepatic carcinoid micrometastases, barely visible to the eye, during routine laparoscopic cholecystectomy is reported. The micrometastases were possibly recognized as a result of a beneficial aspect of laparoscopic surgery, namely the >10x enlargement of tissue/pathologic structures. PMID:9502714

Rixen, D; Köhler, L; Troidl, H

1998-03-01

49

A comparison of transumbilical single-port laparoscopic appendectomy and conventional three-port laparoscopic appendectomy: from the diagnosis to the hospital cost  

PubMed Central

Purpose Recently many cases of appendectomy have been conducted by single-incision laparoscopic technique. The aim of this study is to figure out the benefits of transumbilical single-port laparoscopic appendectomy (TULA) compared with conventional three-port laparoscopic appendectomy (CTLA). Methods From 2010 to 2012, 89 patients who were diagnosed as acute appendicitis and then underwent laparoscopic appendectomy a single surgeon were enrolled in this study and with their medical records were reviewed retrospectively. Cases of complicated appendicitis confirmed on imaging tools and patients over 3 points on the American Society of Anesthesia score were excluded. Results Among the total of 89 patients, there were 51 patients in the TULA group and 38 patients in the CTLA group. The visual analogue scale (VAS) of postoperative day (POD) #1 was higher in the TULA group than in the CTLA group (P = 0.048). The operative time and other variables had no statistical significances (P > 0.05). Conclusion Despite the insufficiency of instruments and the difficulty of handling, TULA was not worse in operative time, VAS after POD #2, and the total operative cost than CTLA. And, if there are no disadvantages of TULA, TULA may be suitable in substituting three-port laparoscopic surgery and could be considered as one field of natural orifice transluminal endoscopic surgery with the improvement and development of the instruments and revised studies.

Baik, Seung Min; Hong, Kyung Sook

2013-01-01

50

Improvised Transumbilical Glove Port: A Cost Effective Method for Single Port Laparoscopic Surgery  

Microsoft Academic Search

Innovations in technology has changed the traditional laparoscopy to be less invasive. Singleport transumbilical laparoscopy\\u000a has emerged to enhance the cosmetic benefits and to decrease the morbidity of the minimally invasive surgery. It has further\\u000a minimized the minimally invasive surgery. However, this technique requires a specialized multichannel port (for introducing\\u000a laparoscope and instruments) which is very costly and in fact,

Elbert Khiangte; Iheule Newme; Partha Phukan; Santanu Medhi

2011-01-01

51

Single-Port Laparoscopic Surgery in Children: Concept and Controversies of the New Technique  

PubMed Central

Single-incision laparoscopic surgery (SILS) is emerging as an alternative technique to conventional laparoscopy for the treatment of common surgical diseases. Despite its wide use, the adoption of SILS in children has been slower since the broad application of minimally invasive techniques in children, in general, has historically lagged behind those in adults. This paper reviews the evolution of SILS from its original conception and its application in the field of pediatric surgery.

Blanco, Felix C.; Kane, Timothy D.

2012-01-01

52

Bile duct injury during laparoscopic cholecystectomy: risk of procedure or professional negligence?  

PubMed

Laparoscopic cholecystectomy introduced in the late eighties has now become the gold standard and has taken the place of conventional cholecystectomy. Bile duct injury during cholecystectomy is an iatrogenic, but rare catastrophe associated with significant morbidity and mortality. The incidence of bile duct injuries during laparoscopic cholecystectomy is 0.1-0.42%. We have presented a patient who underwent laparoscopic cholecystectomy which got complicated with bile duct injury grade four. The complication was recognized three weeks later. A remediation of complications was performed in a reference center with full involvement of the primary surgeon. Key words: laparoscopic cholecystectomy, bile duct injury, professional negligence. PMID:23892871

Denjali?, Amir; Skiljo, Hasan; Be?uli?, Hakija; Jusi?, Aldin; Avdagi?, Nesina; Oru?, Mirza

2013-08-01

53

Ventilatory effects of laparoscopic cholecystectomy under general anesthesia  

Microsoft Academic Search

Purpose  To investigate the ventilatory effect of laparoscopic cholecystectomy in patients under general anesthesia with epidural block.\\u000a \\u000a \\u000a \\u000a Methods  We measured arterial blood gas, pulmonary carbon dioxide elimination (0000126;ECO2), the dead space\\/tidal volume ratio (VD\\/VT), and the alveolar-arterial PO2 difference [(a?a)DO2] just before and 5, 10, 20, 40, and 80 min after peritoneal insufflation in eight patients who underwent laparoscopic cholecystectomy\\u000a under general

Seiji Ishikawa; Koshi Makita; Takeshi Sawa; Hidenori Toyooka; Keisuke Amaha

1997-01-01

54

A Case of Persistent Hiccup after Laparoscopic Cholecystectomy  

PubMed Central

A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.

Marchiani, Costanza; Fabbri, Alessia; Ciuti, Gabriele; Pavellini, Andrea; Mancuso, Francesco; Viligiardi, Riccardo; Moggi Pignone, Alberto

2013-01-01

55

Results and complications of laparoscopic cholecystectomy in childhood  

Microsoft Academic Search

Background  The purpose of our study was to evaluate the results and complications of laparoscopic cholecystectomy in a case series of\\u000a 110 infants.\\u000a \\u000a \\u000a \\u000a Methods  Over a 5-year period (1993–98), we performed laparoscopic cholecystectomy in 110 pediatric patients. Surgery was performed\\u000a at three different institutions by three different surgeons. The patients population was composed of 69 girls and 41 boys;\\u000a their ages ranged

C. Esposito; M. A. Gonzalez Sabin; F. Corcione; R. Sacco; G. Esposito; A. Settimi

2001-01-01

56

The dramatic reality of biliary tract injury during laparoscopic cholecystectomy  

Microsoft Academic Search

Background: Most reports concerning the outcome of patients with biliary tract injury during laparoscopic cholecystectomy come from tertiary\\u000a referral centers, and results could be very different in the everyday practice of community surgeons.\\u000a \\u000a \\u000a \\u000a \\u000a Objective: The objective is to define the presentation, mechanisms, results of treatment, and long-term outcome of biliary tract injuries\\u000a during laparoscopic cholecystectomy in the setting of a

J.-F. Gigot; J. Etienne; R. Aerts; E. Wibin; B. Dallemagne; F. Deweer; D. Fortunati; M. Legrand; L. Vereecken; J.-M. Doumont; P. Van Reepinghen; C. Beguin

1997-01-01

57

[Laparoscopic cholecystectomy in a patient with situs inversus].  

PubMed

Laparoscopic cholecystectomy is the standard approach to manage symptomatic gallbladder stones. However, only twelve patients with total situs invertus have been previously reported in the literature. We report a new case of a 58-year-old patient hospitalized for acute pain of the left hypochondrium with fever. The diagnosis of acute cholecystitis with situs inversus totalis was made following clinical examination and radiological investigations. Laparoscopic cholecystectomy was subsequently performed through a modification of the technique to adapt to the mirror image anatomy. PMID:16460662

Bedioui, H; Chebbi, F; Ayadi, S; Makni, A; Fteriche, F; Ksantini, R; Jouini, M; Kacem, M; Ben Safta, Z

2006-01-19

58

[Minilaparoscopic surgery : alternative or supplement to single-port surgery?].  

PubMed

In recent years scarless surgery (axillo-bilateral-breast aproach [ABBA], natural orifice transluminal endoscopic surgery [NOTES], single-port surgery) has gained importance in order to improve postoperative outcome in laparoscopic surgery. As part of this effort minilaparoscopic surgery might be a suitable alternative concerning cosmetic outcome without implementing a completely new technique. Due to the definition minilaparoscopic surgery is based on instruments which reduce the total length of trocar incisions to less than 2.5 cm. Nevertheless the total number of incisions is similar to conventional laparoscopic techniques. Most recent indications for minilaparoscopic surgery are cholecystectomy, appendectomy, hernia and colorectal surgery. This article describes the technical aspects and feasibility of minilaparoscopic cholecystectomy and transabdominal preperitoneal hernia repair (TAPP).While the trocar positions remain in the original setting the laparoscopic surgeon benefits from experience gained in conventional laparoscopic surgery. Although the cosmetic outcome is not comparable to single-port surgery, in the author's opinion minilaparoscopic surgery is a useful alternative in scarless surgery due to the fact that it is easy to adapt without establishing a completely new technique. PMID:21424297

Brinkmann, L; Lorenz, D

2011-05-01

59

Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy  

Microsoft Academic Search

Accidentai injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion\\u000a to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques,\\u000a laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with\\u000a endoscopic tube or stent insertion in cases of

A.-Hon Kwon; Hiroyuki Inui; Yasuo Kamiyama

2001-01-01

60

Combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy.  

PubMed

A case of combined abdominal wall paresis and incisional hernia after laparoscopic cholecystectomy is reported. The paresis possibly occurred by a lesion of the N. intercostalis when extending the incision for stone extraction. Possibly the paresis was a predisposing factor for the development of an incisional hernia. The causes of abdominal wall paresis are explored with a review of the literature. In spite of minimal trauma to the anterior abdominal wall in laparoscopic procedures, the risk of iatrogenic lesions remains. PMID:10064761

Korenkov, M; Rixen, D; Paul, A; Köhler, L; Eypasch, E; Troidl, H

1999-03-01

61

First experiences with robotic-assisted laparoscopic cholecystectomies  

Microsoft Academic Search

Summary  \\u000a Background: The recent introduction of surgical robotic systems marks a new milestone in surgical medicine comparable to the laparoscopic\\u000a approach in the late 1980s. At Innsbruck University Hospital we have been using the da Vinci™ robotic system (Intuitive Surgical,\\u000a Mountain View, CA, USA) since June 2001. Our first general surgical experiences with this device and laparoscopic cholecystectomies\\u000a are reported

J. Bodner; T. Schmid; H. Wykypiel; E. Bodner

2002-01-01

62

Transcutaneous PCO 2 monitoring during laparoscopic cholecystectomy in pregnancy  

Microsoft Academic Search

Purpose  Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy\\u000a during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and\\u000a hence arterial carbon dioxide (PaCO2) monitoring has been recommended. We report the feasibility and benefits of transcutaneous carbon dioxide monitoring

K. Bhavani-Shankar; R. A. Steinbrook; P. S. Mushlin; D. Freiberger

1998-01-01

63

Laparoscopic laser cholecystectomy: results of the technique in 210 patients.  

PubMed Central

The results of laparoscopic laser cholecystectomy (LLC) in a consecutive series of 210 patients, operated on between May 1990 and August 1991, were assessed to analyse the advantages of the technique and to detail the causes of any technical problems, failures, or complications. The operations were performed by JMcKW and ADNS. A success rate of 98% (206/210) was achieved with a minor complication rate of 13% (26/210) and major complication rate of 3% (7/206), including three patients (3/206; 1.5%) who had a reactionary haemorrhage postoperatively, two requiring laparotomy. The length of hospital stay was 48 h or less in over 80% (148/184) of the patients. The period of absence from work was 2 weeks or less in over 90% (118/130) of the patients. Cholecystectomy can safely be performed laparoscopically and this procedure has significant advantages over open cholecystectomy.

Scott, A. D.; Greville, A. C.; McMillan, L.; Wellwood, J. M.

1992-01-01

64

Factors associated with time to laparoscopic cholecystectomy for acute cholecystitis  

Microsoft Academic Search

AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical).

Chris N Daniak; David Peretz; Jonathan M Fine; Yun Wang; Alan K Meinke; William B Hale

65

Trocar site seeding of inapparent gallbladder carcinoma during laparoscopic cholecystectomy.  

PubMed

There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. A patient is reported here whose primary tumor appeared controlled by surgery and radiation, but who died of the disease after developing implant metastases at three untreated trocar sites. The second case report illustrates the difficulty in identifying gallbladder cancer during laparoscopic cholecystectomy, and the importance of a diligent preoperative effort to establish the diagnosis. Current literature suggests that tumor implantation occurring during laparoscopic cholecystectomy for inapparent carcinoma adversely affects prognosis, and, until the effect of laparoscopy on the spread of this tumor is better understood and controlled, open operation should be performed when carcinoma of the gallbladder is suspected. When laparoscopic cholecystectomy is done for inapparent gallbladder cancer, surgical and adjuvant radiotherapy to the trocar sites appears to improve outcome in association with extended treatment to the gallbladder bed and adjacent areas. Recent reports suggest that progress in diagnostic, surgical, and adjuvant techniques could substantially improve survival in carcinoma of the gallbladder. PMID:8919176

Cotlar, A M; Mueller, C R; Pettit, J W; Schmidt, E R; Villar, H V

1996-02-01

66

Bile duct injury in the era of laparoscopic cholecystectomy  

Microsoft Academic Search

Background: Laparoscopic cholecystectomy is the standard of care for symptomatic cholelithiasis, but it is associated with a higher incidence of bile duct injury than the open approach. Methods: A review was performed of the English language literature on the management of bile duct injury listed on Medline databases. Results and conclusion: There is consensus that careful dissection and correct interpretation

S. Connor; O. J. Garden

2006-01-01

67

Treatment of bile duct lesions after laparoscopic cholecystectomy  

Microsoft Academic Search

From January 1990 to June 1994, 53 patients who sustained bile duct injuries during laparoscopic cholecystectomy were treated at the Amsterdam Academic Medical Centre. There were 16 men and 37 women with a mean age of 47 years. Follow up was established in all patients for a median of 17 months. Four types of ductal injury were identified. Type A

J J Bergman; G R van den Brink; E A Rauws; L de Wit; H Obertop; K Huibregtse; G N Tytgat; D J Gouma

1996-01-01

68

Single-incision laparoscopic cholecystectomy versus traditional four-port cholecystectomy.  

PubMed

Laparoscopic cholecystectomy has traditionally been performed using multiple small sites. Single-incision laparoscopic surgery has emerged as an alternative technique to improve cosmesis and minimize complications associated with multiple incisions. A retrospective study was performed of all patients who underwent laparoscopic cholecystectomy by a single surgeon (DTA) from April 2008 to August 2011. Charts were reviewed for surgical indication, operative technique (multiple vs. single transumbilical incision), operative time, length of stay, and surgical complications. Sixty-three patients underwent laparoscopic cholecystectomy using a traditional approach of four skin incisions, while 62 patients underwent a single-incision transumbilical approach. Average age and sex were comparable between the two groups. Indications for surgery included cholelithiasis, cholecystitis, biliary dyskinesia, biliary pancreatitis, and porcelain gallbladder. Of those undergoing single-incision cholecystectomy, 85% (53/62) went home the same day, compared with 70% (44/63) of those undergoing four-incision cholecystectomy (P = 0.03). Among those not discharged on the same day of surgery, the average length of stay trended shorter in the single-incision group (2.8 days, range 1-6) compared with the four-incision group (3.3 days, range 1-12; P = NS). Operative time was slightly longer for those undergoing single-incision surgery (65 minutes, range 35-141) versus traditional four-incision surgery (51 minutes, range 41-109) (P < 0.001). With this single surgeon's single-incision transumbilical technique, costs were comparable between the two groups. One patient who underwent traditional four-incision cholecystectomy was readmitted for biliary pancreatitis and bacteremia on postoperative day 3. In the single-incision group, one patient was readmitted 1 month later with pancreatitis. In conclusion, single-incision transumbilical laparoscopic cholecystectomy can be an effective alternative to traditional four-incision cholecystectomy, with the added benefit of minimized scarring and a shorter length of stay. A longer operative time may be needed initially to adjust for a learning curve. This technique can be performed safely for patients with a multitude of gallbladder diseases without resulting in additional complications. PMID:23077377

Culp, Brittney L; Cedillo, Veronica E; Arnold, David T

2012-10-01

69

The outcomes of SILS cholecystectomy in comparison with classic four-trocar laparoscopic cholecystectomy  

PubMed Central

Introduction General approval of laparoscopy as well as persistent urge to minimize operative trauma with still existing difficulties in putting natural orifice transluminal endoscopic surgery (NOTES) into practice have contributed to the introduction of laparoscopic operations through one incision in the umbilicus named single incision laparoscopic surgery (SILS). Aim The main aim of this study was to assess the benefits to patients of applying SILS cholecystectomy as a method of gallbladder removal based on the comparison with classic four-port laparoscopic cholecystectomy. Material and methods Between 18.03.2009 and 09.12.2009, 100 patients were included in the study and they underwent elective gallbladder removal by applying the laparoscopic technique. All patients were divided into two equal groups: qualified for SILS cholecystectomy (group I) and qualified for classic four-trocar laparoscopic cholecystectomy (group II), whose ASA physical status was I and II. BMI was limited to 35 kg/m2. Outcome measures included operative time, intensity of postoperative pain and consumption of painkillers, hospital stay, need for conversion, complications, and cosmetic effects. Results Mean operating time in group I was 66 min and in group II 47.2 min. Intensity of pain evaluated by using the visual analogue scale (VAS) 6 h after the operation in group I was 3.49 and in group II 4.53, whereas 24 h after the operation in group I it was 1.18 and in group II 1.55. The painkiller requirement in group I was smaller than in group II. Mean hospital stay after the operation in group I was 1.33 days and in group II 1.96 days. There were 4 conversions in group I and one conversion in group II. Among the complications in group I there were noted 2 cases of right pneumothorax, 1 case of choleperitonitis and 4 complications connected with wound healing. There was one injury of the duodenum and one wound infection in group II. Conclusions Single-incision laparoscopic surgery cholecystectomy can be an alternative to classic laparoscopic cholecystectomy, especially with reference to young people with body mass index less than 35 kg/m2, without serious systemic diseases, operated on electively due to benign gallbladder diseases.

Pesta, Wieslaw; Kowalczyk, Marek; Glowacki, Leszek; Juskiewicz, Wit; Szynkarczuk, Rafal; Snarska, Jadwiga; Stanowski, Edward

2012-01-01

70

[Biliary complications of laparoscopic cholecystectomy: our experience compared with laparotomic cholecystectomy].  

PubMed

Major bile ducts injuries during cholecystectomy were one of the most common complications, but they were becoming rare. With the introduction and the fast diffusion of laparoscopy their incidence has increased. For this reason we have reviewed our experience about open and laparoscopic cholecystectomy. We report 18 patients, 8 male and 10 female with age ranged from 27 to 73 years, with common bile duct injuries. Only three patients (20%) underwent surgery in our Department of Surgery of the University of Cagliari. Of these patients, two were operated on open and one laparoscopic cholecystectomy. They represent 0.08% and 0.36% of the respective groups. The most common cause of this complication is peritonitis (94.5%), followed by bleeding and congenital anomalies of the biliary tree, that were present in 5.5% respectively. The conversion to laparotomy was necessary in 3.9% of our patients, while residual choledocholithiasis in one patient was treated by laparotomic reexploration because of the unsuccessful ERCP. In summary in our opinion the prevention of this complication depends on appropriate indication and choice of the patients, as well as an adequate training. The ERCP, if indicated, must be done before laparoscopic cholecystectomy. PMID:14569918

Nardello, O; Muggianu, M; Farina, G; Cagetti, M

71

[Gasless laparoscopic cholecystectomy using retractor of the abdominal wall].  

PubMed

The Authors present a new gasless laparoscopic cholecystectomy method using an abdominal wall elevator with subcutaneous traction ("laparotenser"). Fifty patients between May 1994 and March 1995 were operated by videolaparoscopy using this new gasless method. Twenty of them were operated with Nagai's method while the laparotenser was used in the remaining thirty. The results obtained are similar to those using pneumoperitoneum. It has been observed a global reduction of costs, less postoperative pain, no influence in cardiovascular and metabolic indexes. No complications were reported during the postoperative period but two cases of conversion to laparotomy not related to the method used were needed. Laparoscopic cholecystectomy without pneumoperitoneum using the subcutaneous elevator of the abdominal wall ("laparotenser") has demonstrated that it's possible to operate in a working space similar to that created by the pneumoperitoneum. After an initial period of distrust towards the laparoscopic methods without pneumoperitoneum it has been accepted that gasless methods multiply the indications to minimally invasive surgery in patients with cardiorespiratory problems considered no ideal candidates to laparoscopic cholecystectomy with pneumoperitoneum. PMID:8679422

D'Urbano, C; Fuertes Guiro, F; Sampietro, R

1996-03-01

72

Use of CO2 laser flexible waveguides during laparoscopic cholecystectomy  

NASA Astrophysics Data System (ADS)

Laparoscopic cholecystectomy has revolutionized the management of symptomatic cholelithiasis and cholecystitis. Although electrosurgery devices are used by a majority of surgeons, laser technology is a valued addition to the armamentarium of the skilled laser laparoscopist. A variety of fiberoptic capable wavelengths have been applied successfully during this procedure. Use of the CO2 laser for this purpose has lagged due to difficulties encountered with free-beam and rigid waveguide dissections via the laparoscope. Recent developments in flexible waveguide technology have the potential to expand the role of the CO2 laser for laparoscopic cholecystectomy and other procedures. Twelve laparoscopic cholecystectomies were performed using Luxar (Bothell, WA) flexible microwaveguides of various configurations. In each case, dissection of the gallbladder from the gallbladder bed was accomplished with acceptable speed and hemostasis. There were no complications. Shortcomings include coupling and positioning with an articulated arm and occasional clogging of some waveguide tips with debris. Modifications of this technology are suggested. Flexible waveguides make the CO2 laser a practical alternative for surgical laparoscopy.

Lanzafame, Raymond J.

1992-06-01

73

Laparoscopic cholecystectomy for a left-sided gallbladder  

PubMed Central

Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe.

Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael

2013-01-01

74

Clostridium perfringens sepsis and liver abscess following laparoscopic cholecystectomy  

PubMed Central

Clostridium perfringens sepsis with intravascular haemolysis is a catastrophic process with a reported mortality of between 90 to 100%. We successfully treated a case of severe clostridial infection with a liver abscess following laparoscopic cholecystectomy, the first to our knowledge. A 59-year-old man presented one week after an uneventful laparoscopic cholecystectomy with jaundice, peritonism, sepsis and acute renal failure. He was found to have a haemolytic anaemia, unconjugated hyperbilirubinemia and blood cultures grew Clostridium perfringens. A CT revealed a large gas forming abscess in the gallbladder fossa and right lobe of liver. He was treated with directed antibiotic therapy and underwent emergency laparotomy, drainage of the abscess and peritoneal washout. He required intensive care support, parenteral nutrition and inotropic support for a limited period. CT liver angiogram post op was normal. Continued renal dysfunction necessitated protracted haemofiltration. This resolved and the patient was discharged home at 2 months.

Qandeel, H; Abudeeb, H; Hammad, A; Ray, C; Sajid, M; Mahmud, S

2012-01-01

75

Impact on laboratory training in subsequent performance of laparoscopic cholecystectomy  

Microsoft Academic Search

Background  The purpose of this study was to evaluate the long-lasting influence of laparoscopic training during residency course on outcomes\\u000a of laparoscopic cholecystectomy (LC).\\u000a \\u000a \\u000a \\u000a Materials and methods  We compared outcomes of LC in patients treated by surgeons who have learned LC by the traditional surgical residency program\\u000a (traditional group; n?=?15) with those of LC operated on by surgeons who received additional intensive

Toshihiko Shinohara; Tetsuji Fujita; Takeyuki Misawa; Taro Sakamoto; Kazuhiko Yoshida; Hideyuki Kashiwagi; Katsuhiko Yanaga

2009-01-01

76

Evaluation of Protocol Uniformity Concerning Laparoscopic Cholecystectomy in The Netherlands  

Microsoft Academic Search

Background  Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol,\\u000a based on the “critical view of safety” concept of Strasberg, should reduce the incidence of this complication. Furthermore,\\u000a owing to the rapid development of minimally invasive surgery, technicians are becoming more frequently involved. To improve\\u000a communication between the operating team and technicians, standardized actions

Linda S. G. L. Wauben; Richard H. M. Goossens; Daan J. van Eijk; Johan F. Lange

2008-01-01

77

Conventional Pneumoperitoneum Compared with Abdominal Wall Lift for Laparoscopic Cholecystectomy  

Microsoft Academic Search

Summary We have compared, in a randomized study, con- ventional carbon dioxide pneumoperitoneum with abdominal wall lift in 25 patients undergoing laparoscopic cholecystectomy. Intra-abdominal pressure (IAP) (11 (SD 2) mm Hg vs 2.7 (9) mm Hg) (P ? 0.01) and total amount of carbon dioxide used (40 (23) litre vs 9 (7) litre) (P ? 0.001) were significantly less with

L. LINDGREN; A.-M. KOIVUSALO; I. KELLOKUMPU; Michele Joseph

1996-01-01

78

LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY PATIENTS. AN EXPERIENCE AT LIAQUAT UNIVERSITY HOSPITAL JAMSHORO  

Microsoft Academic Search

Background: Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of

Arshad M. Malik; K. Altaf Hussain Talpur; Aisha Memon; Rafique Pathan; Jan Mohammad Memon

79

Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients  

PubMed Central

Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (?65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age.

Filho, Euler de Medeiros Azaro; Galvao, Thales Delmondes; Ettinger, Joao Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

2006-01-01

80

Band ligation of the perforated gall bladder during laparoscopic cholecystectomy.  

PubMed

Perforation of the gall bladder is a frequent complication during laparoscopic cholecystectomy. Grasping the perforated part of the gall bladder, clip application, or endoscopic loop application are possible solutions to prevent spillage. We propose laparoscopic rubber band application to close the perforated part of the gall bladder as an easy and safe method. We performed rubber band application after iatrogenic perforation of the gall bladder during laparoscopic cholecystectomy in 5 patients. Two-millimeter-wide multiple rubber rings, cut from a 14-Fr Foley catheter, are loaded on a grasper. When a perforation occurred during the dissection of the gall bladder, the hole is grasped with this instrument and 1 of the rings is placed on the gall bladder by the aid of a dissector. Thus, the grasper remained available for traction of the Hartmann's pouch during further dissection of the gall bladder. The rubber bands were placed successfully in all cases. Two perforations occurred in 1 case, and 2 bands were placed with ease. Bile leakage or gall stone spillage did not occur. Operation time was not prolonged. Rubber band ligation of perforation of the gall bladder is a simple, safe, inexpensive, and effective method to prevent spillage of the bile or gallstones in laparoscopic surgery. PMID:18097314

Derici, Hayrullah; Bozda?, Ali Do?an; Tansug, Tugrul; Nazli, Okay; Reyhan, Enver

2007-12-01

81

Systemic response in patients undergoing laparoscopic cholecystectomy using gasless or carbon dioxide pneumoperitoneum: a randomized study  

Microsoft Academic Search

In general, laparoscopic cholecystectomy produces a surgical stress response very similar to which occurs after open cholecystectomy.\\u000a The question is whether the pneumoperitoneum constitutes a significant pathophysiologic trauma, which might be followed by\\u000a profound changes in the stress response. We conducted a prospective, randomized trial involving 50 consecutive patients scheduled\\u000a for laparoscopic cholecystectomy, who had a body mass index equal

Jens Fromholt Larsen; Per Ejstrud; Flemming Svendsen; Vivi Pedersen; Finn Redke

2002-01-01

82

Laparoscopic Cholecystectomy for Cholelithiasis during Infancy and Childhood: Cost Analysis and Review of Current Indications  

Microsoft Academic Search

. Eleven consecutive laparoscopic cholecystectomies (LCs) were performed between January 1994 and June 1996 compared\\u000a with seven open cholecystectomies (OCs) performed previously at King Khalid University Hospital. The comparison included surgical,\\u000a clinical, and economic factors, together with a review of the literature. In the laparoscopic group the main indication for\\u000a cholecystectomy was symptomatic gallstones. Other indications include mucocele of the

Akram J. Jawad; K. Kurban; Abdulkarim El-Bakry; Abdullah Al-Rabeeah; Mohammed Seraj; Adel Ammar

1998-01-01

83

Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis.  

PubMed Central

OBJECTIVE: The purpose of this study was to perform a meta-analysis of large laparoscopic cholecystectomy case-series and compare results concerning complications, particularly bile duct injury, to those reported in open cholecystectomy case-series. SUMMARY BACKGROUND DATA: Since the introduction of laparoscopic cholecystectomy in the United States, hundreds of reports about the technique have been published, many including statements about the advantages of laparoscopic cholecystectomy compared with those of open cholecystectomy. There is an unevenness in scope and quality of the studies. Nevertheless, enough data have accumulated from large series to permit analyses of data regarding some of the most important issues. METHODS: Articles identified via a MEDLINE (the National Library of Medicine's computerized database) search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes of cholecystectomy were abstracted and summarized across studies. RESULTS: Outcomes of laparoscopic cholecystectomy are examined for 78,747 patients reported on in 98 studies and compared with outcomes of open cholecystectomy for 12,973 patients reported on in 28 studies. Laparoscopic cholecystectomy appears to have a higher common bile duct injury rate and a lower mortality rate. Estimated rates of other types of complications after laparoscopic cholecystectomy generally were low. Most conversions followed operative discoveries (e.g., dense adhesions) and were not the result of injury. CONCLUSIONS: There is wide variability in the amount and type of data reported within any single study, and patient populations may not be comparable across studies. Except for a higher common bile duct injury rate, laparoscopic cholecystectomy appears to be at least as safe a procedure as that of open cholecystectomy.

Shea, J A; Healey, M J; Berlin, J A; Clarke, J R; Malet, P F; Staroscik, R N; Schwartz, J S; Williams, S V

1996-01-01

84

Management of major biliary complications after laparoscopic cholecystectomy.  

PubMed Central

OBJECTIVE: A total of 50 major bile duct injuries after laparoscopic cholecystectomy were managed by the Duke University Hepatobiliary Service from 1990-1992. The management of these complex cases is reviewed. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy is the preferred method for removing the gallbladder. Bile duct injury is the most feared complication of the new procedure. METHODS: Review of videotapes, pathology, and management of the original operations were reviewed retrospectively, and the injuries categorized. Major biliary injury was defined as a recognized disruption of any part of the major extrahepatic biliary system. Biliary leakage was defined as a clinically significant biliary fistula in the absence of major biliary injury, i.e., with an intact extrahepatic biliary system. RESULTS: Thirty-eight injuries were major biliary ductal injuries and 12 patients had simple biliary leakage. Twenty-four patients had the classic type injury or some variant of the classic injury. A standard treatment approach was developed which consisted of ERCP for diagnosis, preoperative PTC with the placement of stents, CT drainage immediately after the PTC for drainage of biliary ascites, and usually Roux-en-Y hepaticojejunostomy with placement of O-rings for future biliary access if necessary. Major ductal injuries were high in the biliary system involving multiple ducts in 31 of the 38 patients. Re-operation was required in 5 of the 38 patients with particularly complex problems. CONCLUSIONS: Successful management of bile duct injury after laparoscopic cholecystectomy requires careful understanding of the mechanisms, considerable preoperative assessment by experts, and a multidisciplinary approach. Images Figure 2. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8.

Branum, G; Schmitt, C; Baillie, J; Suhocki, P; Baker, M; Davidoff, A; Branch, S; Chari, R; Cucchiaro, G; Murray, E

1993-01-01

85

How Managed Care May Choose Hospitals for Contracts for Laparoscopic Cholecystectomy  

PubMed Central

Background and Objectives: Maricopa Medical Center (MMC) was found to have higher charges and length-of-stays than 16 other regional hospitals in an analysis of DRG categories for gallbladder disease. These comparative figures identified MMC as being inefficient and demanded review to determine the reasons for the inefficiencies. Methods: In an attempt to determine the reason for inefficiency of charges and length-of-stay for the laparoscopic portion of laparoscopic cholecystectomy, matched pairs of open cholecystectomy and converted laparoscopic cholecystectomy from a data base of 633 patients with cholecystectomies were reviewed. Thirty-five matches for age, sex and similar diagnosis were successful. Results: Matched pair evaluation disclosed a $6,880 difference in charges, which was attributed solely to the charge for laparoscopy. Subsequent chart analysis showed a high charge for instrumentation, prolonged anesthesia and operative times and longer preoperative delays before surgery. Moreover, no matter what the conversion rate is, open cholecystectomy was more cost effective. However, if there is a conversion rate of 5%, total hospital charges for laparoscopic cholecystectomy would have to be reduced to $12,679 (a reduction of $3,332 from $16,011) to make laparoscopic cholecystectomy cost-effective. Conclusions: Cost-effective decision tree analysis of matched pair comparisons and sensitivity analysis proves to be an effective technique in evaluating the cost-effectiveness of laparoscopic cholecystectomy in a hospital population.

Caruso, Daniel Martin; Wesche, Daniel Eric; Bay, Ralph Curtis

1997-01-01

86

Bile leak after elective laparoscopic cholecystectomy: Role of MR imaging  

PubMed Central

Increasing hepatobiliary laparoscopic surgeries have lead to a rise in injury to the biliary tree and other complications like bile leak. Ultrasonography (US) and computed tomography (CT) cannot reliably distinguish bile from other postoperative fluid collections. Magnetic resonance (MR) imaging with hepatobiliary agents and MR cholangiopancreatography provide anatomic and functional information that allows for prompt diagnosis and excludes any other concomitant complications. We report a case of post-cholecystectomy bile leak in a 42-year-old female who presented with persistent dull abdominal pain after the intervention; we emphasize the role of MR imaging in achieving the correct diagnosis.

Mungai, Francesco; Berti, Valentina; Colagrande, Stefano

2013-01-01

87

Complications of laparoscopic cholecystectomy —An analysis of 2100 operations  

Microsoft Academic Search

\\u000a Summary  Background\\u000a \\u000a Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not\\u000a be inferior to the standard modality in any aspect. Some complications specific to the technique, however, are severe and\\u000a complication rate is higher than in standard open surgery.\\u000a \\u000a \\u000a \\u000a Methods\\u000a \\u000a \\u000a In this paper the authors report their guiding principles in applying

P. Schmidt; P. Ezer; A. Antal

1995-01-01

88

Laparoscopic Cholecystectomy and Appendectomy in Situs Inversus Totalis  

PubMed Central

Situs inversus totalis is an uncommon anatomic anomaly that complicates diagnosis and management of acute abdominal pain. Expedient diagnosis of common intraperitoneal disease processes such as biliary colic, acute appendicitis and diverticulitis is often delayed as a result of seemingly incongruous physical findings. We present the case of a young woman with prior emergency room visits for complaints of a vague left upper quadrant abdominal pain. An ultrasound performed on her third presentation revealed visceral situs inversus with cholelithiasis and dilated intra- and extrahepatic biliary ducts. Standard laparoscopic cholecystectomy and cholangiography with a mirror-image surgical approach was performed successfully and without complication.

Djohan, Risal S.; Rodriguez, Heron E.; Wiesman, Irvin M.; Unti, James A.

2000-01-01

89

Laparoscopic cholecystectomy in adults with sickle cell disease  

Microsoft Academic Search

Background  Chronic hemolysis predisposes adults with sickle cell disease (SCD) to the formation of bilirubinate cholelithiasis.\\u000a \\u000a \\u000a \\u000a Methods  To study the impact of laparoscopic cholecystectomy (LC) on this groups, we reviewed our records of all patients with SCD\\u000a and cholelithiasis treated electively from 1991 to 1999. During that period, 13 consecutive patients with SCD underwent elective\\u000a LC for symptomatic cholelithiasis. Nine patients (69.2%)

G. Bonatsos; K. Birbas; K. Toutouzas; N. Durakis

2001-01-01

90

[Aberrant gallstones--extraordinary complications of laparoscopic cholecystectomy].  

PubMed

About 0.2 % of patients undergoing laparoscopic cholecystetomy will suffer from complications caused by lost gallstones. Diagnostic and therapeutic measures are correlated to the symptoms. At different locations, abscesses can arise, which can be treated by direct access through the -abdominal wall, laparotomy or laparoscopy. Two cases are presented with the especially grave sequels of subphrenic abscess, infiltration of the thoracic wall, and pleural empyema, which -respectively needed several successive operations -after ten years. In laparoscopic cholecystectomy, all detected stones should be removed. In the case of a failure, conversion to laparotomy is not essential. The loss of stones has to be formally -documented, the patient and family doctor are to be informed. PMID:19382051

Büttner, D; Gelbke, R

2009-04-20

91

Thrombosis of Portal Venous System after Laparoscopic Cholecystectomy in a Patient with Prothrombin Gene Mutation  

PubMed Central

Laparoscopic cholecystectomy is now the gold standard for the treatment of symptomatic cholelithiasis. Portal venous thrombosis after laparoscopic cholecystectomy is rare. We report a case of thrombosis of the portal venous system after laparoscopic cholecystectomy in a patient with a latent prothrombin gene mutation. An abdominal computed tomography and magnetic resonance angiogram of the abdomen revealed portal, superior mesenteric, and splenic vein thrombosis. Testing for coagulation disorders showed a heterozygous form of factor II (prothrombin) G20210A mutation. Because of its rarity, information regarding this complication is limited.

Gul, Waheed; Qazi, Arif M.; Markert, Ronald J.; Barde, Christopher J.

2012-01-01

92

Day-Surgery Laparoscopic Cholecystectomy: Factors Influencing Same-Day Discharge  

Microsoft Academic Search

Background  Day-surgery laparoscopic cholecystectomy (LC) should be the procedure of choice in patients with symptomatic gallstone disease.\\u000a This article assesses feasibility, patient outcome and predictive factors for successful day-case laparoscopic cholecystectomy.\\u000a \\u000a \\u000a \\u000a Method  A retrospective analysis of our prospective database of 176 patients following laparoscopic cholecystectomy in a day-surgery\\u000a unit was performed. A telephone interview was conducted within 24 h after discharge and

J. Psaila; S. Agrawal; U. Fountain; T. Whitfield; B. Murgatroyd; M. F. Dunsire; J. G. Gonzalez; A. G. Patel

2008-01-01

93

Mechanisms of major biliary injury during laparoscopic cholecystectomy.  

PubMed Central

Laparoscopic cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. The most significant complication of this new technique is injury to the bile duct. Twelve cases of bile duct injury during laparoscopic cholecystectomy were reviewed. Eight injuries were of a classic type: misidentification of the common duct for the cystic duct, resection of part of the common and hepatic ducts, and associated right hepatic arterial injury. Another injury was similar: clip ligation of the distal common duct with proximal ligation and division of the cystic duct, resulting in biliary obstruction and leakage. Three complications arose from excessive use of cautery or laser in the region of the common duct, resulting in biliary strictures. Evaluation of persistent diffuse abdominal pain led to the recognition of ductal injury in most patients. Ultimately, 10 patients required a Roux-en-Y hepaticojejunostomy to provide adequate biliary drainage. One patient had a successful direct common duct repair, and the remaining patient underwent endoscopic dilatation. Images FIG. 1. FIG. 1. FIG. 2. FIG. 6.

Davidoff, A M; Pappas, T N; Murray, E A; Hilleren, D J; Johnson, R D; Baker, M E; Newman, G E; Cotton, P B; Meyers, W C

1992-01-01

94

Single-Fulcrum Laparoscopic Cholecystectomy in Uncomplicated Gallbladder Diseases: A Retrospective Comparative Analysis with Conventional Laparoscopic Cholecystectomy  

PubMed Central

Purpose Single-fulcrum laparoscopic cholecystectomy (SFLC) is a variant type of single incision and multi-port technique that does not use specialized one-port devices or articulating instruments. We retrospectively compared perioperative outcomes of SFLC with those of conventional laparoscopic cholecystectomy (CLC). Materials and Methods Between March 2009 and December 2010, SFLC was performed in 130 patients. Among them, 105 patients with uncomplicated gallbladder disease (no inflammation or no clinical symptoms) and another 105 patients who underwent CLC were selected for this study. Results There was no open conversion. In comparison with CLC, SFLC was performed more often in young (46.4±12.2 years vs. 52.5±13.6 years, p=0.001) female patients (80/25 vs. 62/43, p=0.008). The total operation time was longer in SFLC (56.7±14.1 min vs. 47.5±17.1 min, p<0.001), but pain scores immediately after operation and at discharge time were lower for SFLC than for CLC (3.1±1.3 vs. 4.0±1.9, p<0.001, 2.0±0.9 vs. 2.4±0.8, p=0.002). Total cost was lower for SFLC than for CLC (US $ 1801±289.9 vs. US $ 2003±617.4, p=0.004). There were no differences in hospital stay or complication rates. Conclusion SFLC showed greater technical feasibility and cost benefits in treating uncomplicated benign gallbladder disease than CLC.

Hwang, Ho Kyoung; Choi, Sung Hoon; Lee, Woo Jung

2013-01-01

95

Results of post-laparoscopic cholecystectomy duplex scan without deep vein thrombosis prophylaxis prior to surgery  

PubMed Central

Backgrounds There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT) in laparoscopic cholecystectomy. The aim of this study was the assessment of patients’ condition after laparoscopic cholecystectomy without any prophylactic measure. Methods 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. Results Only one case of partially thrombosis (1%) was found by duplex scanning which was managed conservatively. Conclusion Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor.

Pakaneh, Mohammad Ali; Tamannaie, Zeinab; Hakimian, Mohammad; Zohrei, Hamid Reza; Chaichian, Shahla

2012-01-01

96

Subphrenic abscess secondary to Actinomycosis meyeri and Klebsiella ozaenae following laparoscopic cholecystectomy.  

PubMed

A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism has not previously been reported in a subphrenic abscess. The etiopathogenesis and management of this condition are presented. PMID:19487988

Zbar, Andrew P; Ranasinghe, Weranja; Kennedy, Philip J

2009-07-01

97

Covert laparoscopic cholecystectomy:a new minimally invasive technique.  

PubMed

To further improve our developed transumbilical endoscopic surgery (TUES), we developed a completely covert laparoscopic cholecystectomy (LC). Twelve cases of LC were recruited for this new approach. First, a 10-mm trocar was placed above the umbilicus for inserting the laparoscope. Two 5-mm trocars were then placed near the right and left ends of the superior margin of the suprapubic hair. After the 5-mm 30° laparoscope was shifted to the left suprapubic trocar, the harmonic scalper, electric hook, and grasper were inserted either through the 10-mm umbilical trocar or through the right suprapubic trocar. All gallbladders were successfully removed without intraoperative complications. The mean operating time was 28.5 ± 5.7 min (range 20-45 min). All patients felt well after surgery and did not need postoperative analgesia. They resumed free oral intake 6h after the procedure. All patients were satisfied with the appearance of the incisions, which were completely hidden in the umbilicus and suprapubic hair. The approach we developed has overcome both external instrument interference around the umbilicus and the loss of triangulation in the operative field. It is relatively simpler than a typical TUES and offers better cosmetic results. PMID:22037269

Hu, Hai; Zhu, Jiang Fan; Huang, An Hua; Xin, Ying; Xu, An An; Chen, Bingguan

2011-10-01

98

Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes.  

PubMed Central

OBJECTIVE: To study the introduction of laparoscopic cholecystectomy to the 43 tertiary-care university-affiliated Veterans Administration medical centers (VAMCs) participating in the National Veterans Affairs Surgical Risk Study from October 1991 through December 1993. SUMMARY BACKGROUND DATA: Previous studies in the private sector have documented growth in the number of cholecystectomies and falling clinical thresholds for cholecystectomy with the introduction of laparoscopic cholecystectomy. METHODS: The following were analyzed for changes over time: measures of patient preoperative risk, complexity of surgery, severity of biliary disease, numbers of procedures, postoperative length of stay, and 30-day postoperative mortality and general complication rates. RESULTS: The number of cholecystectomies performed laparoscopically increased, but the total number of cholecystectomies performed remained stable over time. The proportion of patients with acute cholecystitis, emergent cholecystectomies, and technically complex cholecystectomies did not change or increased slightly over time. Adjusted odds for postoperative general complications were lower for laparoscopic than for open cholecystectomy, but 30-day postoperative mortality and general complication rates for all cholecystectomies remained constant over time. Postoperative length of stay for all cholecystectomies fell significantly. Implementation rates of laparoscopic cholecystectomy varied widely between hospitals. Laparoscopic cholecystectomy was adopted more slowly and used in a lower percentage of cholecystectomies than in non-VA settings. CONCLUSIONS: In contrast to non-VA studies showing increases in overall cholecystectomy volume since the introduction of laparoscopic cholecystectomy, these VAMCs implemented laparoscopic cholecystectomy without growth in cholecystectomies or a change in the clinical threshold for cholecystectomy. Laparoscopic cholecystectomy was associated with better outcomes, but its introduction in the setting of stable cholecystectomy volume and biliary disease case mix did not change postoperative mortality and complication rates. The stable cholecystectomy volume and biliary disease case mix, slower adoption, and lower use of laparoscopic cholecystectomy contrast with previous reports and may result from differences in patients and organization and financing of VA versus non-VA settings.

Chen, A Y; Daley, J; Pappas, T N; Henderson, W G; Khuri, S F

1998-01-01

99

Evaluation of the clinical pathway for laparoscopic cholecystectomy.  

PubMed

Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (+/-768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (+/-618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction. PMID:15757055

Soria, Víctor; Pellicer, Enrique; Flores, Benito; Carrasco, Milagros; Candel Maria, Fe; Aguayo, Jose Luis

2005-01-01

100

Incidental gallbladder cancer during laparoscopic cholecystectomy: Managing an unexpected finding  

PubMed Central

AIM: To evaluate the impact of incidental gallbladder cancer on surgical experience. METHODS: Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery, one university based and one at a public hospital, were retrospectively reviewed. Gallbladder pathology was diagnosed by history, physical examination, and laboratory and imaging studies [ultrasonography and computed tomography (CT)]. Patients with gallbladder cancer (GBC) were further analyzed for demographic data, and type of operation, surgical morbidity and mortality, histopathological classification, and survival. Incidental GBC was compared with suspected or preoperatively diagnosed GBC. The primary endpoint was disease-free survival (DFS). The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention. RESULTS: Nineteen patients (11 women and eight men) were found to have GBC. The male to female ratio was 1:1.4 and the mean age was 68 years (range: 45-82 years). Preoperative diagnosis was made in 10 cases, and eight were diagnosed postoperatively. One was suspected intraoperatively and confirmed by frozen sections. The ratio between incidental and nonincidental cases was 9/19. The tumor node metastasis stage was: pTis (1), pT1a (2), pT1b (4), pT2 (6), pT3 (4), pT4 (2); five cases with stage?Ia (T1 a-b); two with stage?Ib (T2 N0); one with stage?IIa (T3 N0); six with stage?IIb (T1-T3 N1); two with stage III (T4 Nx Nx); and one with stage IV (Tx Nx Mx). Eighty-eight percent of the incidental cases were discovered at an early stage (??II). Preoperative diagnosis of the 19 patients with GBC was: GBC with liver invasion diagnosed by preoperative CT (nine cases), gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case), porcelain gallbladder (one case), gallbladder adenoma (one case), and chronic cholelithiasis (eight cases). Every case, except one, with a T1b or more advanced invasion underwent IVb + V wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy. One patient with stage T1b GBC refused further surgery. Cases with Tis and T1a involvement were treated with cholecystectomy alone. One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone. Six of the nine patients with incidental diagnosis reached 5-year DFS. One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery. Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS. CONCLUSION: Laparoscopic cholecystectomy does not affect survival if implemented properly. Reoperation should have two objectives: R0 resection and clearance of the lymph nodes.

Cavallaro, Andrea; Piccolo, Gaetano; Panebianco, Vincenzo; Menzo, Emanuele Lo; Berretta, Massimiliano; Zanghi, Antonio; Vita, Maria Di; Cappellani, Alessandro

2012-01-01

101

Applications of lasers in laparoscopic cholecystectomy: technical considerations and future directions  

NASA Astrophysics Data System (ADS)

Interest in lasers has increased exponentially due to the meteoric growth of laparoscopic cholecystectomy. This paper reviews the laser technologies available for laparoscopic use. The relative merits and liabilities for each wavelength and delivery system are discussed. Considerations for future developments of these technologies are provided.

Lanzafame, Raymond J.

1991-07-01

102

Robotic Single-Port Hernia Surgery  

PubMed Central

Background and Objectives: Since the introduction of single-incision laparoscopic surgery in 2009, an increasing number of surgical procedures including hernia repair are being performed using this technique. However, its large-scale adoption awaits results of prospective randomized controlled studies confirming its potential benefits. Parallel with single-port surgery development, the issue of the chronic lack of good camera assistants is being addressed by the robotic Freehand® camera controller, which has the potential to replace camera assistants in a large percentage of routine laparoscopic surgery. Although the robotic Freehand has been used in certain operations in urology and gynecology, there have been no published reports in robotic (single-port) hernia surgery. Methods: This study reports the first case and a series of 16 patients who underwent robotic single-port total extraperitoneal inguinal hernia repair compared to 16 consecutive cases of conventional single-port inguinal hernia repair. Patients were matched for age, sex, body mass index, American Society of Anesthesiologists classification, and types of hernia. Results: Although operation time was comparable in both, the time wasted for scope cleaning was 8.5 minutes for conventional compared to 1.5 minutes for robotic surgery. Conclusion: Robotic single-port inguinal hernia repair is feasible and efficient. This represents a further milestone in laparoscopic surgery.

2011-01-01

103

Factors associated with time to laparoscopic cholecystectomy for acute cholecystitis  

PubMed Central

AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery. RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01). CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.

Daniak, Chris N; Peretz, David; Fine, Jonathan M; Wang, Yun; Meinke, Alan K; Hale, William B

2008-01-01

104

Laparoscopic cholecystectomy: day-care versus clinical observation.  

PubMed Central

OBJECTIVE: To determine the feasibility and desirability of laparoscopic cholecystectomy (LC) in day-care versus LC with clinical observation. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy has been performed regularly as outpatient surgery in patients with uncomplicated gallstone disease in the United States, but this has not been generally accepted in Europe. The main objections are the risk of early severe complications (bleeding) or other reasons for readmission, and the argument that patients might feel safer when observed for one night. Quality-of-life differences hitherto have not been investigated. METHODS: Eighty patients (American Society of Anesthesiology [ASA] I/II) with symptomatic gallstones were randomized to receive LC either in day-care or with clinical observation. Complications, (re)admissions, consultations of general practitioners or the day-care center within 4 days after surgery, use of pain medication, quality of life, convalescence period, time off from professional activities, and treatment preference were assessed. The respective costs of day-care and clinical observation were determined. RESULTS: Of the 37 patients assigned to the day-care group who underwent elective surgery, 92% were discharged successfully after an observation period of 5.7+/-0.2 hours. The remainder of the patients in this group were admitted to the hospital and clinically observed for 24 hours. For the 37 patients in the clinical observation group who underwent elective surgery, the observation time after surgery was 31+/-3 hours. Three patients in the day-care group and one patient in the clinical observation group had complications after surgery. None of the patients in either group consulted a general practitioner or the hospital during the first week after surgery. Use of pain medication was comparable in both groups over the first 48 hours after surgery. There were no differences in pain and other quality-of-life indicators between the groups during the 6 weeks of follow-up. Of the patients in the day-care group, 92% preferred day-care to clinical observation. The same percentage of patients in the clinical observation group preferred at least 24 hours of observation to day-care. Costs for the day-care patients were substantially lower (approximately $750/patient) than for the clinical observation patients. CONCLUSION: Effectiveness was equal in both patient groups, and both groups appeared to be satisfied with their treatment. Because no differences were found with respect to the other outcomes, day-care is the preferred treatment in most ASA I and II patients because it is less expensive.

Keulemans, Y; Eshuis, J; de Haes, H; de Wit, L T; Gouma, D J

1998-01-01

105

Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography.  

PubMed

Although pneumoperitoneum has been well tolerated in a predominantly healthy population, there is concern that an increased intraperitoneal pressure may be poorly tolerated in patients with marginal cardiopulmonary function. The purpose of this study was to demonstrate noninvasively the hemodynamic effects of carbon dioxide pneumoperitoneum utilizing biplane transesophageal echocardiography. Fourteen otherwise-healthy patients undergoing nonemergent laparoscopic cholecystectomy were studied using bi-plane transesophageal echocardiography under a standardized anesthetic protocol utilizing isoflurane, fentanyl, and vecuronium bromide. End-tidal CO2, oxygen saturation, cardiac rhythm, temperature, and blood pressure were monitored noninvasively. Minute ventilatory volume was adjusted as needed to keep end-tidal CO2 less than 38 mmHg. Data were recorded at baseline, following abdominal insufflation to 15 mmHg with CO2, with head-up tilt of 20 degrees, following exsufflation, and with the patient level. Significance was determined using a paired Student t-test. Insufflation to 15 mmHg decreased cardiac index (C.I.) by 3% (3.34 to 3.23 l/min/m2) while both heart rate (HR) and mean arterial pressure (MAP) increased (by 7% and 16%), respectively, and stroke volume index decreased by 10% (from 51.6 to 46.6 ml/beat/m2). Head-up tilt of 20 degrees further decreased CI to 2.98 l/min/m2 (-11%) and SVI to 40.3 ml/beat/m2 (-22%) while HR increased by a total of 14% and MAP by 19%. As laparoscopic techniques are applied to a broader population, the impact of small but significant decrements in cardiac function become increasingly important. This study demonstrates that the combination of CO2 pneumoperitoneum and the reverse Trendelenburg position does adversely effect cardiac output. PMID:7597579

Dorsay, D A; Greene, F L; Baysinger, C L

1995-02-01

106

Embolism of a Metallic Clip: An Unusual Complication following Laparoscopic Cholecystectomy  

Microsoft Academic Search

A 32-year-old woman underwent laparoscopic cholecystectomy during which there was severe bleeding from the bed of the gallbladder. As application of metallic clips to control the bleeding was not successful, the operation was converted to an open laparotomy. Cholecystectomy was successfully completed without further complications, and the post-operative course was uneventful and the patient was discharged. Eighteen months later, the

Karlheinz Ammann; Johannes Kiesenebner; Michael Gadenstätter; Gebhard Mathis; Franz Stoss

2000-01-01

107

Laparoscopic cholecystectomy bile duct injuries: more than meets the eye.  

PubMed

Laparoscopic cholecystectomy (LC) has rapidly become standard treatment of symptomatic cholelithiasis. Its advantages are well known, while its risks have not been well defined. The most common major complication of LC is bile duct injury. Over the past year, we have treated six patients for this problem. Injuries included: one partial laceration of the common bile duct; one partial laceration of the common hepatic duct; three complete common hepatic duct transections at the bifurcation, and one clip obstruction of the right hepatic duct. Intraoperative cholangiography was performed in two of six patients. Injury was recognized in these two cases, which were converted to celiotomy for immediate repair. One was repaired primarily; the other required a hepaticojejunostomy. Injuries were not identified at LC in four. Three of the four patients required biliary-enteric reconstruction procedures. With a mean follow-up period of 13 months, four of six patients remain symptomatic. LC does carry a real risk of bile duct injury. Routine intraoperative cholangiography may decrease this risk or at least allow early recognition and repair when it has occurred. Conversion to an open procedure is not a complication of LC but rather a sign of good surgical judgement. Patients not following the routine postoperative course must be evaluated for a possible bile duct injury to prevent the morbidity of delayed diagnosis. PMID:8338285

Rantis, P C; Greenlee, H B; Pickleman, J; Prinz, R A

1993-08-01

108

Single-site incision laparoscopic cholecystectomy in children: a single-center initial experience.  

PubMed

Laparoscopic cholecystectomy is the standard approach in most pediatric surgical centers. In an attempt to further minimize the surgical trauma and improve cosmetic outcome, new techniques with a single incision through the umbilicus have been proposed. There are still few reports concerning this technique in the pediatric population. We evaluated the feasibility of the single incision for laparoscopic cholecystectomy in children. We performed the operation in 10 patients, with a mean age of 12 years, mean operating time of 122 minutes, and mean hospital stay of 2 days. No complications occurred, and no conversion to open surgery was needed. In 1 patient, an extra 5-mm port was necessary. The cosmetic results were very satisfactory. In our experience, despite its technical difficulty and initial learning curve, single-incision laparoscopic cholecystectomy in the pediatric population is a safe and feasible method. PMID:22152896

Mesas Burgos, Carmen; Ghaffarpour, Nader; Almström, Markus

2011-12-01

109

Single-incision laparoscopic cholecystectomy: a comparison with the gold standard  

Microsoft Academic Search

Background  Single-incision laparoscopic cholecystectomy (SILC) may be a comparable alternative to conventional multiport laparoscopic\\u000a cholecystectomy (LC). This study compared procedural outcomes and costs between SILC and LC.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective review of patients undergoing SILC over an 8-month period was performed. A cohort of LC patients from the\\u000a same surgeons over the preceding 8 months was used as historic controls. Demographics, comorbidities, diagnosis,

Sigi Joseph; B. Todd Moore; G. Brent Sorensen; John W. Earley; Fengming Tang; Phil Jones; Kimberly M. Brown

110

Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach  

PubMed Central

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

Fernandes, Mauro Neiva; Neiva, Ivan Nazareno Campos; de Assis Camacho, Francisco; Meguins, Lucas Crociati; Fernandes, Marcelo Neiva; Meguins, Emilia Maira Crociati

2008-01-01

111

Left-sided gallbladder discovered during laparoscopic cholecystectomy in a patient with dextrocardia.  

PubMed

Left-sided gallbladder, a rare congenital anomaly, is often associated with transposition of single or multiple viscera of thorax and/or abdomen. Clinical features and routine presurgical ultrasonography could miss the anomalous position thereby producing unnecessary anxiety during surgery. Here we are reporting a patient with left-sided gallbladder, known to have dextrocardia with multiple intracardiac anomalies, and detected incidentally in a series of 1258 consecutive laparoscopic cholecystectomies. Laparoscopic cholecystectomy was performed successfully in this patient with port site modification and careful dissection. Some degree of abdominal visceral situs inversus is to be anticipated in patients with dextrocardia. PMID:23542707

Sadhu, Sagar; Jahangir, Tarshid A; Roy, Manas K

2011-04-19

112

The First Korean Experience of Telemanipulative Robot-Assisted Laparoscopic Cholecystectomy Using the da Vinci System  

PubMed Central

With the advancement of laparoscopic instruments and computer sciences, complex surgical procedures are expected to be safely performed by robot assisted telemanipulative laparoscopic surgery. The da Vinci system (Intuitive Surgical, Mountain View, CA, USA) became available at the many surgical fields. The wrist like movements of the instrument's tip, as well as 3-dimensional vision, could be expected to facilitate more complex laparoscopic procedure. Here, we present the first Korean experience of da Vinci robotic assisted laparoscopic cholecystectomy and discuss the introduction and perspectives of this robotic system.

Kang, Chang Moo; Chi, Hoon Sang; Hyeung, Woo Jin; Kim, Kyung Sik; Choi, Jin Sub; Kim, Byong Ro

2007-01-01

113

Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique  

Microsoft Academic Search

Background  Over the last two decades, laparoscopic cholecystectomy has become the gold standard for treating cholecystolithiasis and\\u000a an index operation for evaluation and assessment of laparoscopic surgical skills. Its wider application and continuous refinement\\u000a have not been accompanied by a commensurate decrease in morbidity due to biliary, vascular, or visceral injuries. Use of an\\u000a energy source, especially monopolar electrosurgery, has been

Brij Agarwal; Manish Gupta; Sneh Agarwal; Krishan Mahajan

2007-01-01

114

Incidence, Risk Factors, and Prevention of Biliary Tract Injuries during Laparoscopic Cholecystectomy in Switzerland  

Microsoft Academic Search

.   Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) which may result in patient disability or death are reported\\u000a to occur more frequently when compared to open surgery. The aim of this nationwide prospective study beyond the laparoscopic\\u000a learning curve was to analyze the incidence, risk factors, and management of major BDI. During a 3-year period (1995–1997)\\u000a 130 items of

Lukas Krähenbühl; Guido Sclabas; Moritz N. Wente; Markus Schäfer; Rolf Schlumpf; Markus W. Büchler

2001-01-01

115

Comparison of long-term quality of life after laparoscopic and open cholecystectomy  

Microsoft Academic Search

  Background: Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the\\u000a laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the\\u000a two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of\\u000a these two cholecystectomy techniques

Ö. Topçu; F. Karakayali; M. A. Kuzu; S. Özdemir; N. Erverdi; A. Elhan; N. Aras

2003-01-01

116

Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy  

SciTech Connect

Purpose. Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.

Perini, Rafael F. [Medical University of South Carolina, Division of Gastroenterology (United States); Uflacker, Renan [University of South Carolina, Division of Interventional Radiology (United States)], E-mail: uflacker@musc.edu; Cunningham, John T. [Medical University of South Carolina, Division of Gastroenterology (United States); Selby, J. Bayne [University of South Carolina, Division of Interventional Radiology (United States); Adams, David [University of South Carolina, Division of GI Surgery (United States)

2005-04-15

117

Retrobulbar metastasis from gallbladder carcinoma after laparoscopic cholecystectomy. A case report.  

PubMed

Extra-abdominal metastases from gallbladder cancer are very rare; the sites outside the abdomen most frequently affected are the skin, bone and central nervous system. In the literature, only one case of orbital metastasis from gallbladder cancer has been reported, in a patient previously treated by open cholecystectomy. We report the case of a 53-year-old woman who underwent a laparoscopic cholecystectomy for symptomatic gallbladder stones. Postoperative histological examination revealed an unsuspected gallbladder adenocarcinoma. One month later she came to our observation after having developed diplopia and ophthalmic pain due to an orbital metastasis. We decided not to perform a surgical second look because of the already rapid dissemination of the malignant tumor. The few cases of uncommon gallbladder cancer metastases after laparoscopic cholecystectomy described in the literature are discussed, as well as the possible role of laparoscopy in the dissemination and localized seeding of malignant cells. PMID:16459642

Puglisi, Francesco; Capuano, Palma; Gentile, Antonia; Lobascio, Pierluigi; Russo, Silvana; Martines, Gennaro; Lograno, Giuseppe; Memeo, Vincenzo

118

Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia  

PubMed Central

BACKGROUND AND OBJECTIVES: Problems during laparoscopic cholecystectomy include bile duct injury, conversion to open operation, and other postoperative complications. We retrospectively evaluated the causes for conversion and the rate of conversion from laparoscopic to open cholecystectomy and assessed the postoperative complications. METHODS: Of 340 patients who presented with symptomatic gall bladder disease over a 2-year period, 290 (85%) patients were evaluated on an elective basis and scheduled for surgery, while the remaining 50 (14.7%) patients were admitted emergently with a diagnosis of acute cholecystitis. RESULTS: The mean age of the patients was 41.9 (12.6) years. Conversion to laparotomy occurred in 17 patients (5%). The incidence of complications was 3.2%. The most common complication was postoperative transient pyrexia, which was seen in four patients (1.2%) followed by postoperative wound infection in three patients (0.9%), postoperative fluid collection and bile duct injury in two patients each (0.6%). CONCLUSION: Laparoscopic cholecystectomy remains the ‘gold standard’ by which all other treatment modalities are judged. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertise.

Ghnnam, Wagih; Malek, Jawid; Shebl, Emad; Elbeshry, Turky; Ibrahim, Ahmad

2010-01-01

119

[Laparoscopic cholecystectomy for acute cholecystitis in pregnancy: a case report in woman with situs viscerum inversus].  

PubMed

We report a case of a three month young pregnant woman (In Vitro Fertilization and Embryo Transfer - IVF-ET - twin pregnancy) with situs viscerum inversus totalis affected by acute cholecystitis. As already happened in other pregnant women, we use laparoscopic approach and cholecystectomy is performed successfully without any morbidity for mother and fetuses. PMID:23258242

Pezzolla, Angela; Lattarulo, Serafina; Disabato, Maria; Barile, Graziana; Primiceri, Giuliana; Paradies, Daniele

2012-12-01

120

The advantages of simultaneous abdominoplasty, laparoscopic cholecystectomy, and incisional hernia repair  

Microsoft Academic Search

. A 44-year-old woman undergoing abdominoplasty, laparoscopic cholecystectomy, and incisional hernia repair is presented. Abdominal wall lipodystrophy and incisional hernia, both pathologies leading to esthetic deformity, and cholelithiasis causing biliary symptoms were treated at the same operation without any complications. Combining two or multiple abdominal procedures may reduce the potential risks of multiple anesthesia for each procedure, shorten total hospital

F. Özgur; A. Aksu; Ö. Özkan; E. Hamaloglu

2002-01-01

121

Intent at Day Case Laparoscopic Cholecystectomy in Owerri, Nigeria: Initial Experiences  

PubMed Central

Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m2 , American Society of Anaesthesiology physical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery. Results: Twelve patients (10 females, 2 males) were worked up with the intent of achieving same-day discharge of the patients. Five of the patients (41.7%) were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment.

Ekwunife, Christopher Nonso; Njike, Chioma Ijeoma

2013-01-01

122

Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography  

Microsoft Academic Search

Controversy over whether intraoperative cholangiography (IOC) should be done routinely has intensified since the advent of laparoscopic cholecystectomy (LC). As yet, no study has demonstrated a clear benefit to its use, although their have been suggestions in the literature that routine use may confer an advantage to detection of injuries. One-hundred seventy-seven biliary tract complications occurring secondary to LC were

M. S. Woods; L. W. Traverso; R. A. Kozarek; J. H. Donohue; D. R. Fletcher; J. G. Hunter; M. Oddsdottir; R. L. Rossi; J. Tsao; J. Windsor

1995-01-01

123

What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations  

PubMed Central

OBJECTIVE: Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy is still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decided to review the rate and causes of conversion from laparoscopic to open cholecystectomy. METHOD: This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from May 1999 to June 2010. The exclusion criteria were malignancy and/or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rate of conversion to open cholecystectomy, the underlying reasons for conversion, and postoperative complications were also analyzed. RESULTS: Of 5382 patients for whom LC was attempted, 5164 were included this study. The overall rate of conversion to open cholecystectomy was 3.16% (163 patients). There were 84 male and 79 female patients; the mean age was 52.04 years (range: 26–85). The conversion rates in male and female patients were 5.6% and 2.2%, respectively (p<0.001). The most common reasons for conversion were severe adhesions caused by tissue inflammation (97 patients) and fibrosis of Calot's triangle (12 patients). The overall postoperative morbidity rate was found to be 16.3% in patients who were converted to open surgery. CONCLUSION: Male gender was found to be the only statistically significant risk factor for conversion in our series. LC can be safely performed with a conversion rate of less than 5% in all patient groups.

Genc, Volkan; Sulaimanov, Marlen; Cipe, Gokhan; Basceken, Salim Ilksen; Erverdi, Nezih; Gurel, Mehmet; Aras, Nusret; Hazinedaroglu, Selcuk M

2011-01-01

124

Modified transumbilical laparoscopic cholecystectomy: double-incision, triple-port access.  

PubMed

Transumbilical laparoscopic cholecystectomy has been increasingly performed in recent years, using special access devices and instruments through one incision in the umbilicus. We have modified the technique by using a two-incision triple-port access approach and conventional laparoscopic instruments. A total of 52 patients accepted the modified transumbilical laparoscopic cholecystectomy, and all the procedures were completed successfully. The operative time was 150 minutes for the first case, 100 minutes and 90 minutes for the second and third cases, and an average of 50 ± 14 minutes for the following 49 cases. All patients were discharged on post-operative day 3. No complications were observed during a follow-up of at least three months. The umbilical incisions were nearly invisible, and all patients were satisfied with the abdominal cosmetic results.In conclusion, transumbilical laparoscopic cholecystectomy using a double-incision triple-port access approach and conventional laparoscopic instruments as described in this study is safe and feasible, and it reduces the conflict of instruments without using special devices. PMID:22793779

Zhang, Hai-Feng; Lu, Chun-Lei; Gao, Ying; Chen, Dong-Feng; Wang, Wei-Jia

2012-07-16

125

Raising the thinker: new concept for dissecting the cystic pedicle during laparoscopic cholecystectomy.  

PubMed

Imprecise dissection due to poor visualization of anatomic structures is among the major causes of biliary injuries during laparoscopic cholecystectomy. Developing new illustrational and rendering techniques represents an important part in decreasing visual deception and subsequent bile duct injuries. We use the model of one of the most well-known pieces of art, Rodin's The Thinker, to visualize the gallbladder and cystic pedicle structures. This minimizes visual deception before dissection, especially in cases with obscured structures. Our method, raising The Thinker, is based on the remarkable similarity between the sculpture and the topographic anatomy of the gallbladder. The method can be used not only for better orientation and visualization during laparoscopic cholecystectomy but also as a tool to complement the teaching of laparoscopic biliary anatomy to surgical residents and medical students. PMID:22184309

Neychev, Vladimir; Saldinger, Pierre F

2011-12-01

126

Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery?  

Microsoft Academic Search

Background  Morbid obesity is associated with a high prevalence of cholecystopathy, and there is an increased risk of cholelithiasis during\\u000a rapid weight loss following gastric bypass. In the era of open gastric bypass prophylactic cholecystectomy was advocated.\\u000a However, routine cholecystectomy at laparoscopic gastric bypass is controversial.\\u000a \\u000a \\u000a \\u000a Methods  We performed a retrospective review of a prospectively maintained database of morbidly obese patients undergoing

O. N. Tucker; P. Fajnwaks; S. Szomstein; R. J. Rosenthal

2008-01-01

127

Laparoscopic cholecystectomy in situs inversus totalis: Feasibility and review of literature  

PubMed Central

INTRODUCTION Situs inversus totalis is a rare anomaly characterized by transposition of organs to the opposite site of the body. Laparoscopic cholecystectomy in those patients is technically more demanding and needs reorientation of visual-motor skills to left upper quadrant. PRESENTATION OF CASE Herein, we report a 10 year old boy presented with left hypochondrium and epigastric pain 2 months duration. The patient had not been diagnosed as situs inversus totalis before. The patient exhibit a left sided “Murphy's sign”. Diagnosis of situs inversus totalis was confirmed with ultrasound, computerized tomography (CT) and magnetic resonant image (MRI) with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy for cholelithiasis. DISCUSSION Feasibility and technical difficulty in diagnosis and treatment of such case pose challenge problem due to the contra lateral disposition of the viscera. Difficulty is encountered in skelatonizing the structures in Calot's triangle, which consume extra time than normally located gall bladder. A summary of additional 50 similar cases reported up to date in the medical literature is also presented. CONCLUSION Laparoscopic cholecystectomy is feasible and should be done in situs inversus totalis by experienced laparoscopic surgeon, as changes in anatomical disposition of organ not only influence the localization of symptoms and signs arising from a diseased organ but also imposes special demands on the diagnosis and surgical skills of the surgeon.

Salama, Ibrahim Abdelkader; Abdullah, Mohammed Hussein; Houseni, Mohammed

2013-01-01

128

Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study  

PubMed Central

Purpose Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. Methods Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. Results A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). Conclusion In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.

Arun, Oguzhan; Apiliogullari, Seza; Acar, Fahrettin; Alptekin, Husnu; Calisir, Ak?n; Sahin, Mustafa

2013-01-01

129

Endoclip Migration into the Common Bile Duct with Stone Formation: A Rare Complication after Laparoscopic Cholecystectomy  

PubMed Central

Introduction: Endoclip migration into the common bile duct after laparoscopic cholecystectomy is a rare complication. Very few cases have been reported in the literature, mostly in the form of case reports. Case Description: We report a case of Endoclip migration into the bile duct with stone formation 6 y after laparoscopic cholecystectomy. The patient presented with recurrent abdominal pain and intermittent jaundice for 6 mo. Diagnosis was suspected when a computed tomography scan of the abdomen showed a metallic density artifact in the lower end of the bile duct. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography. The patient was successfully managed by endoscopic stone and clip removal. Discussion: Endoclip migration with biliary complications should be considered in the differential diagnosis of postcholecystectomy problems. The clinical manifestations and management are similar to that of noniatrogenic choledocholithiasis.

Bhattacharya, Sankar Prasad

2013-01-01

130

Laparoscopic Cholecystectomy in a Patient With a Biventricular Cardiac Assist Device  

PubMed Central

Evaluation and management of abdominal pathology in patients with ventricular assist devices is likely to become increasingly important as the utilization of these devices expands. Ventricular assist devices represent a class of intracorporeal or paracorporeal mechanical devices that augment cardiac output in patients with congestive heart failure. Patients with ventricular assist devices supporting both right and left ventricles (biventricular assist devices) are uniquely challenging to the general surgeon because these devices restrict direct access to the abdominal cavity and because of the perioperative implications of biventricular heart failure. We describe herein the first reported successful laparoscopic cholecystectomy in a patient with a paracorporeal biventricular assist device. Cholecystectomy was performed in this patient for acute cholecystitis that occurred while the patient was awaiting heart transplantation. Our results add weight to the small body of evidence that laparoscopy is well tolerated in ventricular assist devices patients. The unique aspects of the biventricular assist device patient make laparoscopic abdominal intervention particularly suitable in this patient population.

Korman, Jeremy; Kleisli, Thomas; Magliato, Kathy E.

2005-01-01

131

Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases  

Microsoft Academic Search

Background and objective  Single-incision laparoscopic surgery (SILS) is a new advance wherein laparoscopic surgery is carried out through a single\\u000a small incision hidden in the umbilicus. Advantages of this technique over standard laparoscopy are still under investigation.\\u000a The objective of this study is to describe the short-term outcomes of SILS cholecystectomy in a single community-based institution.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective review of a

Chris EdwardsAlan; Alan Bradshaw; Paul Ahearne; Pierre Dematos; Ted Humble; Randy Johnson; David Mauterer; Peeter Soosaar

2010-01-01

132

Laparoscopic Cholecystectomy in View of Medical Technology Assessment  

Microsoft Academic Search

When any new procedure or technique is inaugurated and practiced, it is essential to assess its worth. New technologies have a characteristic life cycle which is characterized by a sequence: promising reports, professional adoption, public acceptance as a standard procedure, professional denunciation, and finally discreditation. Endoscopic surgery, especially laparascopic cholecystectomy, is an extremely promising innovation. In order to avoid the

Hans Troidl; Ernst Eypasch; Ahmed Al-Jaziri; Wolfgang Spangenberger; Achim Dietrich

1991-01-01

133

Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials  

Microsoft Academic Search

Background\\/purpose  With the advent of minimally invasive gallbladder surgery, and now with natural orifice techniques emerging, visceral nociception\\u000a has been neglected as a cause of postoperative pain. A systematic review and metaanalysis was carried out to investigate the\\u000a use of intraperitoneal local anesthetic (IPLA) in order to assess its role in laparoscopic cholecystectomy (LC). The aim of\\u000a this systematic review was

Arman Kahokehr; Tarik Sammour; Mattias Soop; Andrew G. Hill

2010-01-01

134

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation  

Microsoft Academic Search

Purpose: The standard laryngeal mask airway LMA-Classic was designed as an alternative to the endotracheal tube (ETT) or the face\\u000a mask for use with either spontaneous or positive pressure ventilation. Positive pressure ventilation may exploit leaks around\\u000a the LMA cuff, leading to gastric distension and\\/or inadequate ventilation. We compared gastric distension and ventilation\\u000a parameters with LMAvs ETT during laparoscopic cholecystectomy.

J. Roger Maltby; Michael T. Beriault; Neil. C. Watson; Gordon H. Fick

2000-01-01

135

Sonographic features of intra-abdominal abscess caused by spilled stones during laparoscopic cholecystectomy  

Microsoft Academic Search

Spillage of stones into the abdominal cavity resulting from perforation of the gallbladder is one of the common complications\\u000a of laparoscopic cholecystectomy. Although many surgeons know that stones left in the abdominal cavity can cause late visceral\\u000a abscess requiring surgical treatment, the sonographic features of such abscesses have not yet to be thoroughly investigated.\\u000a We investigated the sonographic features of

Masamichi Matsuda; Goro Watanabe; Masaji Hashimoto; Harushi Udagawa; Chikao Okuda; Kazuo Takeuchi

2003-01-01

136

Management of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy  

Microsoft Academic Search

The common and distressing complications of postoperative nausea and vomiting (PONV) are the main concern of 40–70% of patients\\u000a undergoing laparoscopic cholecystectomy (LC). The first step in preventing PONV after LC is to reduce the risk factors involving\\u000a patient characteristics, surgical procedure, anesthetic technique, and postoperative care. Particularly, the use of propofol-based\\u000a anesthesia can reduce the incidence of PONV after

Yoshitaka Fujii

2011-01-01

137

A nontransfusional perioperative management regimen for patients with sickle cell disease undergoing laparoscopic cholecystectomy  

Microsoft Academic Search

Background  Patients with sickle cell disease (SCD) are at increased risk for cholelithiasis. Laparoscopic cholecystectomy is the most\\u000a frequent general surgical operation performed for this group of patients. Acute chest syndrome (ACS) is the most common cause\\u000a of postoperative death among SCD patients. This study aimed to evaluate the impact of a novel perioperative management regimen\\u000a involving prophylactic continuous positive airways

D. R. Leff; T. Kaura; T. Agarwal; S. C. Davies; J. Howard; A. C. Chang

2007-01-01

138

Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic cholecystectomy  

Microsoft Academic Search

Among the potential hazards of laparoscoplc surgery using electrocautery IS the release of chermcal byproducts of incomplete\\u000a tissue combustion into the pneumoperitoneum with subsequent transpentoneal absorption into the bloodstream and\\/or release\\u000a into the operatmg room. The purpose of this study of patients undergoing laparoscopic cholecystectomy (LC) was twofold (1)\\u000a to assess the relationship between intraperitoneal concentration of carbon monoxide (CO)

Justin S. Wu; Terri Monk; Donna R. Luttmann; Thomas A. Meininger; Nathaniel J. Soper

1998-01-01

139

The consequences of a major bile duct injury during laparoscopic cholecystectomy  

Microsoft Academic Search

Bile duct injury is perhaps the most feared complication of laparoscopic cholecystectomy. The focus of this study was on the\\u000a immediate and short-term outcome of patients who have undergone repair of major bile duct injuries with respect to hospital\\u000a stay, perioperative interventions, and reoperations. The records of patients who underwent surgery at three academic hospitals\\u000a in Philadelphia (Hospital of the

Todd W. Bauer; Jon B. Morris; Adam Lowenstein; Charles Wolferth; Francis E. Rosato; Ernest F. Rosato

1998-01-01

140

Management of major bile duct injury after laparoscopic cholecystectomy: a case report  

PubMed Central

Introduction Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 0.6% incidence of bile duct injury during laparoscopic cholecystectomy. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic cholecystectomy. Case presentation A rare case of a 48-year-old Greek woman with a triple bile duct injury (right and left hepatic duct ligation and common bile duct cross-section) is presented. A Roux en Y hepaticojejunostomy was performed after repeated endoscopic retrograde cholangiopancreatographies, percutaneous transhepatic catheterization of the ducts and magnetic resonance cholangiographies to delineate the biliary anatomy and assess the level of injury. Conclusion Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

2009-01-01

141

Abdominal wall abscess containing gallstones as a late complication to laparoscopic cholecystectomy performed 17 years earlier  

PubMed Central

Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for symptomatic gallstones. The laparoscopic procedure is superior to the open approach in many aspects. Intraperitoneal spillage of bile and gallstones is one of the most common accidental occurrences of LC. We present a case of a 53-year-old woman who developed two abscesses­—one intra-abdominally and one in the abdominal wall—17 years after an LC. Three gallstones were found during surgical excision of the abdominal wall abscess. Surgeons should strive to avoid perforation of the gall bladder during LC. If spillage is inevitable attempts should be made to laparoscopically extract as many stones as possible. Documentation of (suspected) spillage is paramount when evaluating the possibility of postoperative complications, even many years later.

Christensen, Anders Mark; Christensen, Mads Mark

2013-01-01

142

Gallbladder-associated ectopic liver: A rare finding during a laparoscopic cholecystectomy  

PubMed Central

INTRODUCTION Ectopic hepatic tissue is due to an uncommon failure of embryological liver development that is rarely described in the world medical literature. The incidence of ectopic liver (EL) has been reported to be anywhere from 0.24% to 0.47% as diagnosed at laparotomy or laparoscopy. We describe a case of EL adherent to the gallbladder, removed at laparoscopic cholecystectomy. PRESENTATION OF CASE A 37-year-old female was admitted for elective cholecystectomy having had an episode of acute cholecystitis provoked by gallstones. During the procedure, a 30 mm × 10 mm × 5 mm section of EL tissue attached to the anterior wall of the gallbladder was identified and removed by en-bloc excision during laparoscopic cholecystectomy. Histological examination confirmed the absence of malignant degeneration of the hepatic tissue. The patient recovered well postoperatively and was discharged the day after the operation. She was well when seen six months later. DISCUSSION EL has been reported in several sites, such as the gallbladder, gastrohepatic ligament, adrenal glands, esophagus, and thoracic cavity. EL is often clinically silent and discovered incidentally during abdominal surgical procedures or autopsies. Because patients with ectopic liver may suffer complications such as torsion, peritoneal bleeding, fatty change, and evolution to cirrhosis or malignant degeneration to hepatocellular carcinoma, any ectopic liver tissue needs to be correctly identified and removed. CONCLUSION Despite the rare occurrence of EL, it should be recognized and removed by the surgeon to prevent a higher risk of complications and malignant transformation.

Martinez, Carlos Augusto Real; de Resende, Herminio Cabral; Rodrigues, Murilo Rocha; Sato, Daniela Tiemi; Brunialti, Cyntia Viegas; Palma, Rogerio Tadeu

2013-01-01

143

Technical difficulties and its remedies in laparoscopic cholecystectomy in situs inversus totalis: A rare case report  

PubMed Central

INTRODUCTION Laparoscopic cholecystectomy is considered to be the gold standard surgical procedure for cholelithiasis and is one of the commonest surgical procedures in the world today. However, in rare cases of previously undiagnosed situs inversus totalis (with dextrocardia), the presentation of the cholecystitis, its diagnosis and the operative procedure can pose problems. We present here one such case and discuss how the diagnosis was made and difficulties encountered during surgery and how they were coped with. PRESENTATION OF CASE A 35 year old female presented with left hypochondrium pain and dyspepsia, for 2 years. A diagnosis of cholelithiasis with situs inversus was confirmed after thorough clinical examination, abdominal and chest X-rays and ultrasonography of the abdomen. Laparoscopic cholecystectomy, which is the standard treatment, was performed with numerous modifications in the positioning of the monitor, insufflator, ports and the position of the members of the surgical team and the laparoscopic instruments. The patient had an uneventful recovery. DISCUSSION Situs inversus totalis is itself a rare condition and when associated with cholelithiasis poses a challenge in the management of the condition. We must appreciate the necessity of setting up the operating theatre, the positioning of the ports, the surgical team and the instruments. CONCLUSION Therefore, it becomes important for the right handed surgeons to modify their techniques and establish a proper hand eye coordination to adapt to the mirror image anatomy of the Calot's triangle in a patient of situs inversus totalis.

Arya, S.V.; Das, Anupam; Singh, Sunil; Kalwaniya, Dheer Singh; Sharma, Ashok; Thukral, B.B.

2013-01-01

144

The LMA-ProSeal™ is an effective alternative to tracheal intubation for laparoscopic cholecystectomy  

Microsoft Academic Search

Purpose  To compare LMA-ProSeal™ (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension\\u000a during laparoscopic cholecystectomy.\\u000a \\u000a \\u000a \\u000a Methods  We randomized 109 ASA I–III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg·m?2). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT

J. Roger Maltby; Michael T. Beriault; Neil C. Watson; David Liepert; Gordon H. Fick

2002-01-01

145

Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy  

Microsoft Academic Search

Background and aims  Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have\\u000a not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications\\u000a prospectively in patients on chronic oral anticoagulation.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant

Metin Ercan; Erdal B. Bostanci; Ilter Ozer; Murat Ulas; Yusuf B. Ozogul; Zafer Teke; Musa Akoglu

2010-01-01

146

Estimated costs of biliary tract complications in laparoscopic cholecystectomy based upon Medicare cost\\/charge ratios  

Microsoft Academic Search

Background: Costs of laparoscopic cholecystectomy (LC)-associated biliary tract complications are poorly documented.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A retrospective, case-controlled study attempted to define costs in an institution-specific manner, as compared to a group\\u000a of patients who underwent an uncomplicated LC at the same institution. Costs were estimated by obtaining actual hospital billing\\u000a charges and multiplying them by each hospital's specific Medicare cost-to-charge ratio

M. S. Woods

1996-01-01

147

General Anaesthesia for Laparoscopic Cholecystectomy in a Patient with the Kearns-Sayre Syndrome  

PubMed Central

We report a case of a 40-year-old man affected by the Kearns-Sayre syndrome who underwent an elective laparoscopic cholecystectomy under general anaesthesia. We describe the management of general anaesthesia in this rare myopathy, with emphasis on the use of rocuronium as muscle blocking agent. Induction was achieved with propofol and fentanyl, and general anaesthesia was maintained with fentanyl and sevoflurane/N2O/O2 mixture. The anaesthetic plan proved to be safe and effective, and extubation was achieved in the operating theatre. The postoperative recovery of the patient was satisfactory and uneventful.

Calzavacca, Paolo; Schmidt, Walter; Guzzi, Manuela

2011-01-01

148

General anaesthesia for laparoscopic cholecystectomy in a patient with the kearns-sayre syndrome.  

PubMed

We report a case of a 40-year-old man affected by the Kearns-Sayre syndrome who underwent an elective laparoscopic cholecystectomy under general anaesthesia. We describe the management of general anaesthesia in this rare myopathy, with emphasis on the use of rocuronium as muscle blocking agent. Induction was achieved with propofol and fentanyl, and general anaesthesia was maintained with fentanyl and sevoflurane/N(2)O/O(2) mixture. The anaesthetic plan proved to be safe and effective, and extubation was achieved in the operating theatre. The postoperative recovery of the patient was satisfactory and uneventful. PMID:22606396

Calzavacca, Paolo; Schmidt, Walter; Guzzi, Manuela

2012-01-15

149

Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings  

PubMed Central

Background After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. This study focuses on a difference in costs between laparoscopic and small-incision cholecystectomy from a societal perspective with emphasis on internal validity and generalisability Methods A blinded randomized single-centre trial was conducted in a general teaching hospital in The Netherlands. Patients with reasonable to good health diagnosed with symptomatic cholecystolithiasis scheduled for cholecystectomy were included. Patients were randomized between laparoscopic and small-incision cholecystectomy. Total costs were analyzed from a societal perspective. Results Operative costs were higher in the laparoscopic group using reusable laparoscopic instruments (difference 203 euro; 95% confidence interval 147 to 259 euro). There were no significant differences in the other direct cost categories (outpatient clinic and admittance related costs), indirect costs, and total costs. More than 60% of costs in employed patients were caused by sick leave. Conclusion Based on differences in costs, small-incision cholecystectomy seems to be the preferred operative technique over the laparoscopic technique both from a hospital and societal cost perspective. Sick leave associated with convalescence after cholecystectomy in employed patients results in considerable costs to society. Trial registration ISRCTN Register, number ISRCTN67485658.

Keus, Frederik; de Jonge, Trudy; Gooszen, Hein G; Buskens, Erik; van Laarhoven, Cornelis JHM

2009-01-01

150

A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy.  

PubMed Central

Septic complications are rare following laparoscopic cholecystectomy if prophylactic antibiotics are given, as demonstrated in previous studies. Antibiotic treatment may be unnecessary and, therefore, undesirable, so we compared two forms of prophylaxis: a cephalosporin antibiotic and bag extraction of the dissected gallbladder. A total of 76 patients undergoing laparoscopic cholecystectomy were randomised to either receive an antibiotic or to have their gallbladder removed from the abdomen in a plastic bag. Complicated cases were excluded. There was a total of 6 wound infections (7.9%), 3 in each of the study groups. All these were associated with skin commensals. There were no other septic complications. Bacteriological studies grouped the organisms isolated from the bile and the wound as potential pathogens and likely commensals. A total of 10 potential pathogens were isolated, 9 of which were found in the group receiving antibiotics. We conclude that septic sequelae of uncomplicated laparoscopic cholecystectomy are uncommon, but clearly not entirely prevented by antibiotic or mechanical prophylaxis. Prophylactic antibiotics may not be required in uncomplicated laparoscopic cholecystectomy. Further study is warranted.

Harling, R.; Moorjani, N.; Perry, C.; MacGowan, A. P.; Thompson, M. H.

2000-01-01

151

Minilaparotomy cholecystectomy with ultrasonic dissection versus conventional laparoscopic cholecystectomy: a randomized multicenter study.  

PubMed

Abstract Objective. Cholecystectomy by minilaparotomy (MC) or by laparoscopy (LC) has been shown to have equal results of both early and late recovery. Although, the ultrasonic dissection (UsD) technique has seen used in LC, the technique is rarely used in MC. Material and methods. Initially, 88 patients with uncomplicated symptomatic gallstones were randomized into MC with UsD (n = 44) or conventional LC (n = 44) over a 2-year period (2010-2012). The two groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results. Both groups were similar in terms of the operative time and the time in the operation theatre, the success of day-surgery and satisfaction with the procedure. The MC group had significantly less postoperative pain than the LC group, p = 0.002, and the MC group used less analgesics doses during the first 24 h: 2.8 (1.2) doses vs. 3.8 (1.4) doses, p = 0.003. The convalescence needed was 3 days shorter in the MC group, 7 (3) days, than that in the LC-group, 10 (8) days, p = 0.024. In the MC group 4 patients and in the LC group 11 (p = 0.046) required more than 14 days of sick leave. In the MC group there was one and in the LC group two conversions to open surgery. Conclusion. The patients in the MC group had less early postoperative pain and had a shorter convalescence than the patients in the LC group. PMID:23971855

Harju, Jukka; Juvonen, Petri; Kokki, Hannu; Remes, Veikko; Scheinin, Tom; Eskelinen, Matti

2013-08-26

152

Haemodynamic and End tidal CO? Changes during Laparoscopic Cholecystectomy under General Anaesthesia.  

PubMed

A prospective observational study was done on 50 patients to investigate the haemodynamic and end tidal CO? (EtCO?) changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in head up position under standard protocol of general anaesthesia. During surgery, intra abdominal pressure was maintained at 15 mmHg by a CO? insufflator and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. Haemodynamic parameters, EtCO?, SpO? and ECG were recorded before and after induction and positioning of the patients and at 5 minutes interval for the first 30 minutes, then 10 minutes interval for the rest of the period. Highly significant increase (p<0.001) in pulse rate, systolic, diastolic and mean arterial pressure occurred at 30 minutes after insufflations and positioning of the patient. A very highly significant (p<0.001) increase in EtCO? from the base line was at 40 minutes after insufflations and positioning of the patients. There was no change in SpO? and ECG. This study supports the significant physiological changes in terms of haemodynamic and EtCO? during laparoscopic cholecystectomy and recommends the meticulous monitoring of these parameters during the surgery and balance the benefit of laparoscopy against the intra operative risk. PMID:23982535

Meftahuzzaman, S M; Islam, M M; Chowdhury, K K; Rickta, D; Ireen, S T; Choudhury, M R; Islam, M R; Kabir, H

2013-07-01

153

The Analgesic Effect of Nefopam with Fentanyl at the End of Laparoscopic Cholecystectomy  

PubMed Central

Background Nefopam is a centrally acting analgesic that is used to control pain. The aim of this study was to find an appropriate dose of nefopam that demonstrates an analgesic effect when administered in continuous infusion with fentanyl at the end of laparoscopic cholecystectomy. Methods Ninety patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive analgesia with fentanyl alone (50 µg, Group 1, n = 30), or with fentanyl in combination with nefopam 20 mg (Group 2, n = 30) or in combination with nefopam 40 mg (Group 3, n = 30) at the end of surgery. Pain and side effects were evaluated at 10 minutes, 30 minutes, 1 hour, 2 hours, 6 hours, and 12 hours after arrival in the post-anesthesia care unit (PACU). Results Pain was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes, 2 hours, and 6 hours after arrival in the PACU. Nausea was statistically significantly lower in Group 2 than in Groups 1 and 3 at 10 minutes after arrival in the PACU. Shivering was statistically significantly lower in Groups 2 and 3 than in Group 1 at 10 minutes after arrival in the PACU. Conclusions Nefopam is a drug that can be safely used as an analgesic after surgery, and its side effects can be reduced when fentanyl 50 µg is injected with nefopam 20 mg.

Lee, Ju Hwan; Kim, Jae Hong

2013-01-01

154

Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study  

PubMed Central

Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Materials and Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002), but not in the later period. Conclusion: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.

Hussain, Aziza M.; Khan, Fauzia A.; Ahmed, Aliya; Chawla, Tabish; Azam, Syed I.

2013-01-01

155

Bile duct injury after laparoscopic cholecystectomy: the value of endoscopic retrograde cholangiopancreatography.  

PubMed Central

This study describes the value of endoscopic retrograde cholangiopancreatography (ERCP) in patients with bile duct injury after laparoscopic cholecystectomy. Twelve consecutive patients were studied over a one year period. In all patients the biliary tree was visualised during ERCP. Four patients had complete bile duct obstruction, seven patients had a stricture (two with concomitant leakage), and one patient had leakage from a hepatic branch. Three patients with complete obstruction, presented with a relatively prolonged symptom free, 'silent' period before diagnosis. In all four patients with complete transection, a proximal hepaticojejunostomy was performed. In one patient with a tough fibrous stricture, secondary to incorrect clip placement, passage of the guidewire was impossible, leaving surgical reconstruction as the only therapeutic option. All remaining seven patients with leakage or strictures, or both were successfully treated by endoscopic sphincterotomy only (n = 1) or sphincterotomy and subsequent stent placement (n = 6). When patients do not recover uneventfully after laparoscopic cholecystectomy even without cholestasis or jaundice, early ERCP is recommended as a safe and valuable method to detect bile duct injury and to suggest treatment. Subsequently, more than half of such patients can be treated endoscopically. Extended follow up is needed to evaluate the longterm results. Images Figure 1 Figure 2 Figure 3 Figure 4

Davids, P H; Ringers, J; Rauws, E A; de Wit, L T; Huibregtse, K; van der Heyde, M N; Tytgat, G N

1993-01-01

156

Laparoendoscopic single-site cholecystectomy vs three-port laparoscopic cholecystectomy: A large-scale retrospective study  

PubMed Central

AIM: To perform a large-scale retrospective comparison of laparoendoscopic single-site cholecystectomy (LESSC) and three-port laparoscopic cholecystectomy (TPLC) in a single institution. METHODS: Data were collected from 366 patients undergoing LESSC between January 2005 and July 2008 and were compared with the data from 355 patients undergoing TPLC between August 2008 and November 2011 in our department. Patients with body mass index greater than 35 kg/m2, a history of major upper abdominal surgery, signs of acute cholecystitis, such as fever, right upper quadrant tenderness with or without Murphy’s sign, elevated white blood cell count, imaging findings suggestive of pericholecystic fluid, gallbladder wall thickening > 4 mm, and gallstones > 3 cm, were excluded to avoid bias. RESULTS: Altogether, 298 LESSC and 315 TPLC patients met the inclusion criteria. The groups were well matched with regard to demographic data. There were no significant differences in terms of postoperative complications (contusion: 19 vs 25 and hematoma at incision: 11 vs 19), hospital stay (mean ± SD, 1.4 ± 0.2 d vs 1.4 ± 0.7 d) and visual analogue pain score (mean ± SD, 8 h after surgery: 2.3 ± 1.4 vs 2.3 ± 1.3 and at day 1: 1.2 ± 0.4 vs 1.3 ± 1.2) between the LESSC and TPLC patients. Four patients required the addition of extra ports and 2 patients were converted to open surgery in the LESSC group, which was not significantly different when compared with TPLC patients converted to laparotomy (2 vs 2). LESSC resulted in a longer operating time (mean ± SD, 54.8 ± 11.0 min vs 33.5 ± 9.0 min), a higher incidence of intraoperative gallbladder perforation (56 vs 6) and higher operating cost (mean ± SD, 1933.7 ± 64.4 USD vs 1874.7 ± 46.2 USD) than TPLC. No significant differences in operating time (mean ± SD, 34.3 ± 6.0 min vs 32.7 ± 8.7 min) and total cost (mean ± SD, 1881.3 ± 32.8 USD vs 1876.2 ± 33.4 USD) were found when the last 100 cases in the two groups were compared. A correlation was observed between reduced operating time of LESSC and increased experience (Spearman rank correlation coefficient, -0.28). More patients in the LESSC group expressed satisfaction with the cosmetic result (98% vs 85%). CONCLUSION: LESSC is a safe and feasible procedure in selected patients with benign gallbladder diseases, with the significant advantage of cosmesis.

Cheng, Yuan; Jiang, Ze-Sheng; Xu, Xiao-Ping; Zhang, Zhi; Xu, Ting-Cheng; Zhou, Chen-Jie; Qin, Jia-Sheng; He, Guo-Lin; Gao, Yi; Pan, Ming-Xin

2013-01-01

157

PLMA vs. I-gel: A Comparative Evaluation of Respiratory Mechanics in Laparoscopic Cholecystectomy  

PubMed Central

Background: Supraglottic airway devices (SADs), such as ProSealTM laryngeal mask airway (PLMA), which produce high oropharyngeal seal pressure (OSP) and have the facility for gastric decompression have been used in laparoscopic procedures. i-gel is a new SAD which shares these features with the PLMA. This study was designed to compare the respiratory mechanics of these two devices during positive pressure ventilation in anaesthetised adult patients undergoing laparoscopic cholecystectomy. Patients & Methods: The study included 60 ASA I-II adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized to two groups of 30 each, with either PLMA or i-gel as their airway device. Anaesthesia and premedication were standardized for both the groups. In addition to routine monitoring, neuromuscular monitoring with TOF ratio, OSP and respiratory mechanics monitoring (dynamic compliance, resistance, work of breathing, measured minute ventilation and peak airway pressures) were employed. Fibreoptic evaluation of positioning of the devices and adverse events related to them were also compared. Results: The OSP (cm H2O) were higher for PLMA (38.9 vs. 35.6, P=0.007). The respiratory mechanics parameters using the two devices were comparable apart from the dynamic compliance, which was significantly higher with i-gel (P < 0.05). Malrotation was higher with i-gel than with PLMA (15 vs. 5, P = 0.006). Conclusion: The PLMA formed a better seal while the dynamic compliance was higher with the i-gel. Both devices provided optimal ventilation and oxygenation and the adverse events were also comparable.

Sharma, Bimla; Sehgal, Raminder; Sahai, Chand; Sood, Jayashree

2010-01-01

158

Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials  

PubMed Central

Background Cholecystectomy is associated with increased risks in patients with cirrhosis. The well-established advantages of laparoscopic surgery may be offset by the increased risk for complications relating particularly to portal hypertension and coagulopathy. Methods A systematic search was undertaken to identify studies comparing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with cirrhosis. A meta-analysis was performed of the available randomized controlled trials (RCTs). Results Forty-four studies were analysed. These included a total of 2005 patients with cirrhosis who underwent laparoscopic (n= 1756) or open (n= 249) cholecystectomy, with mortality rates of 0.74% and 2.00%, respectively. A meta-analysis of three RCTs involving a total of 220 patients was conducted. There was a reduction in the overall incidences of postoperative complications and infectious complications and a shorter length of hospital stay in LC. However, frequencies of postoperative hepatic insufficiency did not differ significantly. Conclusions There are few RCTs comparing OC and LC in patients with cirrhosis. These studies are small, heterogeneous in design and include almost exclusively patients with Child–Pugh class A and B disease. However, LC appears to be associated with shorter operative time, reduced complication rates and reduced length of hospital stay.

Laurence, Jerome M; Tran, Peter D; Richardson, Arthur J; Pleass, Henry C C; Lam, Vincent W T

2012-01-01

159

Application of wound closure Molndal technique after laparoscopic cholecystectomy--initial comparative study.  

PubMed

Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons. Colonized and infected wounds are a potential source for cross-infection. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag--Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group treated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration, mostly in the subumbilical incision. In the traditional technique group 7 (14%) patients developed wound infection also predominantly in the subumbilical incision. The difference was statistically significant (p < 0.01). Our results are clearly showing that Molndal technique is effective in preventing the infection of subumbilical incision wound and is to by recommend for regular use at designated site after laparoscopic cholecistectomy. PMID:21305739

Marinovi?, Marin; Cicvari?, Tedi; Jureti?, Iva; Grzalja, Nikola; Medved, Igor; Ahel, Juraj

2010-04-01

160

Liver transplantation for "mass-forming" sclerosing cholangitis after laparoscopic cholecystectomy?  

PubMed Central

INTRODUCTION Chronic biliary obstruction consequence of a bile duct injury may require liver transplantation (LT) in case of secondary biliary cirrhosis, intractable pruritus or reiterate episodes of cholangitis. “Mass-forming” sclerosing cholangitis leading to secondary portal vein thrombosis and pre-sinusoidal portal hypertension has not been reported so far. PRESENTATION OF CASE We present the case of a patient who underwent laparoscopic cholecystectomy for Mirizzi syndrome. The persistent bile duct obstruction due to a residual gallstone fragment was treated by a prolonged biliary stenting. Following repeated bouts of cholangitis, a fibrous centrohepatic scar developed, conglobating and obstructing the main branches of the portal vein and of the biliary tree. The patient developed secondary portal vein thrombosis and portal hypertension. After an extensive diagnostic work-up, including surgical exploration to rule out malignancy, the case was successfully managed by liver transplantation. DISCUSSION Mass-forming sclerosis of the bile duct and biliary bifurcation may develop as a consequence of chronic biliary obstruction and prolonged stenting. Secondary portal vein thrombosis and pre-sinusoidal portal hypertension represents an unusual complication, mimicking Klatskin tumor. CONCLUSION A timely and proper management of post-cholecystectomy complications is of mainstay importance. Early referral to a specialized hepato-biliary center is strongly advised.

Patrono, Damiano; Mazza, Elena; Paraluppi, Gianluca; Strignano, Paolo; David, Ezio; Romagnoli, Renato; Salizzoni, Mauro

2013-01-01

161

Delayed assessment and eager adoption of laparoscopic cholecystectomy: Implications for developing surgical technologies  

PubMed Central

Despite the prevailing emphasis in the medical literature on establishing evidence, many changes in the practice of surgery have not been achieved using proper evidence-based assessment. This paper examines the adoption of laparoscopic cholecystectomy (LC) into regular use for the treatment of cholecystitis and the process of its acceptance, focusing on the limited role of technology assessment in its appraisal. A review of the published medical literature concerning LC was performed. Approximately 3000 studies of LC have been conducted since 1985, and there have been nearly 8500 publications to date. As LC was adopted enthusiastically into practice, the results of outcome studies generally showed that it compared favorably with the traditional, open cholecystectomy with regard to mortality, complications, and length of hospital stay. However, despite the rapid general agreement on surgical technique, efficacy, and appropriateness, there remained lingering doubts about safety, outcomes, and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard. Using LC as a case study, there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice. We highlight one recent example, natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.

Allori, Alexander C; Leitman, I Michael; Heitman, Elizabeth

2010-01-01

162

Abdominal aortic aneurysm with symptomatic cholelithiasis: report of a case treated by simultaneous endovascular aneurysm repair and laparoscopic cholecystectomy.  

PubMed

Asymptomatic cholelithiasis with abdominal aortic aneurysm (AAA) is one of few ideal fields for simultaneous "open" repair. In AAA cases with acute lithiasic cholecystitis, the simultaneous open repair is debatable due to increased possibility for prosthetic graft contamination. We report a case of a 78-year-old, ASA IV patient suffering from acute cholecystitis and concomitant (62 mm) AAA. The patient was treated by simultaneous endovascular AAA repair with a bifurcated prosthesis Endurant and laparoscopic cholecystectomy. Operative time was 165 minutes with total blood loss <100 mL. The patient fed and mobilized the second postoperative day, and the course until patients' discharge the sixth day was uneventful. Follow-up imaging at first month confirmed the successful aneurysm's exclusion without endoleak or migration. The simultaneous endovascular AAA repair and laparoscopic cholecystectomy seems to be simple, safe, and effective technique and minimized the possibility of local and systemic postoperative complications. PMID:23047410

Pitoulias, Georgios A; Papaziogas, Basilios T; Atmatzidis, Stefanos K; Papadimitriou, Dimitrios K

2012-10-01

163

Severe wound traction-blisters after inadequate dressing application following laparoscopic cholecystectomy: case report of a preventable complication  

PubMed Central

Background The inadequate application of postoperative dressings can lead to significant complications, including skin injuries, compartment syndromes, and potential limb loss. To our knowledge, the occurrence of post laparoscopic cholecystectomy related skin complications have not yet been reported in the peer-reviewed literature. Case Presentation Following laparoscopic cholecystectomy for symptomatic gallstone disease, a seventy eight year old healthy white male broke out in painful erythema on either side of his epigastric port site. Vesicles akin to a partial thickness burns were revealed upon removal of dressings. An unusual indentation created by the dressing, and skin traction by the dressing's adhesive edges were implicated, raising questions about technique of its application. Conclusion Incorrect application of wound dressings can disrupt skin architecture, causing painful blistering. This complication should not occur to patients, as it is theoretically 100% preventable. Avoidance of stretching adhesive dressings, and careful adherence to relevant manufacturers' instructions are recommended.

2011-01-01

164

Single-incision laparoscopic cholecystectomy for cholecystolithiasis coinciding with cavernous transformation of the portal vein: report of a case  

PubMed Central

Background Cavernous transformation of the portal vein (CTPV) is a rare vascular deformity. It is thought to be secondary to extra-hepatic portal vein obstruction, with formation of serpiginous collateral vessels around the extra-hepatic bile duct, and even the gallbladder. Surgery is difficult because the vessels have irregular courses, are somewhat fragile and bleed easily. Single-incision laparoscopic cholecystectomy, an emerging procedure for symptomatic cholecystolithiasis, has limitations especially in anatomically complex cases. Case presentation We describe a 44-year-old woman with symptomatic cholecystolithiasis. Computed tomography revealed a series of tortuous collateral veins at the liver hilum, with the extra-hepatic portal vein occluded at the level of the spleno-portal junction. However, the distended vessels were not particularly close to the cystic duct. We performed single-incision laparoscopic surgery (SILS) for cholecystectomy via a trans-umbilical incision. By pulling the cystic duct out along with neighboring cavernous vessels, we were able to secure detachment of the cystic duct from Calot’s triangle and ligation of the cystic artery. Total operating time was 132 minutes and blood loss was 370 grams. The patient was discharged on postoperative day 2 with no perfusion abnormalities in the liver. Conclusion We must pay meticulous attention to the area of Calot’s triangle when performing SILS cholecystectomy with CTPV. SILS cholecystectomy might be an option in highly experienced facilities.

2013-01-01

165

Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis  

Microsoft Academic Search

Six hundred twenty-two laparoscopic cholecystectomies were performed at St. Vincent Hospital over a 14-month period. We reviewed the records of 366 of these patients who were referred to the authors. Thirty-six patients had suspected choledocholithiasis. The primary author (M.E.A.) performed 38 endoscopic retrograde cholangiopancreatography (ERCPs) on these patients for diagnosis and management. Seventeen of the 36 patients had common bile

Maurice E. Arregui; Chad J. Davis; Alan M. Arkush; Robert F. Nagan

1992-01-01

166

Dissection by Ultrasonic Energy Versus Monopolar Electrosurgical Energy in Laparoscopic Cholecystectomy  

PubMed Central

Introduction: Laparoscopic cholecystectomy is the gold standard for management of symptomatic gallstones. Electrocautery remains the main energy form used during laparoscopic dissection. However, due to its risks, search is continuous for safer and more efficient forms of energy. This review assesses the effects of dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy. Methods: A literature search of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, and EMBASE was performed. Studies included were trials that prospectively randomized adult patients with symptomatic gallstone disease to either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Data were collected regarding the characteristics and methodological quality of each trial. Outcome measures included operating time, gallbladder perforation rate, bleeding, bile leak, conversion rate, length of hospital stay and sick leave, postoperative pain and nausea scores, and influence on systemic immune and inflammatory responses. For metaanalysis, the statistical package RevMan version 4.2 was used. For continuous data, Weighted Mean Difference (WMD) was calculated with 95% confidence interval (CI) using the fixed effects model. For Categorical data, the Odds Ratio (OR) was calculated with 95% confidence interval using fixed effects model. Results: Seven trials were included in this review, with a total number of 695 patients randomized to 2 dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. No mortality was recorded in any of the trials. With ultrasonic dissection, operating time is significantly shorter in elective surgery (WMD ?8.19, 95% CI ?10.36 to ?6.02, P>0.0001), acute cholecystitis (WMD ?17, 95% CI ?28.68 to ?5.32, P=0.004), complicated cases (WMD ?15, 95% CI ?28.15 to ?1.85, P=0.03), or if surgery was performed by trainee surgeons who had performed >10 procedures (P=0.043). Gallbladder perforation risk with bile leak or stone loss is lower (OR 0.27, 95% CI 0.17 to 0.42, P>0.0001 and OR 0.13, 95% CI 0.04 to 0.47, P=0.002 respectively), particularly in the subgroup of complicated cases (OR 0.24 95% CI 0.09 to 0.61, P=0.003). Mean durations of hospital stay and sick leave were shorter with ultrasonic dissection (WMD ?0.3, 95% CI ?0.51 to ?0.09, P=0.005 and WMD ?3.8, 95% CI ?6.21 to ?1.39, P=0.002 respectively), with a smaller mean number of patients who stayed overnight in the hospital (OR 0.18, 95% CI 0.03 to 0.89, P=0.04). Postoperative abdominal pain scores at 1, 4, and 24 hours were significantly lower with ultrasonic dissection as were postoperative nausea scores at 2, 4, and 24 hours. Conclusion: Based on a few trials with relatively small patient samples, this review does not attempt to advocate the use of a single-dissection technology but rather to elucidate results that could be used in future trials and analyses. It demonstrates, with statistical significance, a shorter operating time, hospital stay and sick leave, lower gallbladder perforation risk especially in complicated cases, and lower pain and nausea scores at different postoperative time points. However, many of these potential benefits are subjective, and prone to selection, and expectation bias because most included trials are unblinded. Also the clinical significance of these statistical results has yet to be proved. The main disadvantages are the difficulty in Harmonic scalpel handling, and cost. Appropriate training programs may be implemented to overcome the first disadvantage. Cost remains the main universal issue with current ultrasonic devices, which outweighs the potential clinical benefits (if any), indicating the need for further cost-benefit analysis.

2010-01-01

167

Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration  

PubMed Central

Background: Pain experienced following laparoscopic cholecystectomy is largely contributed by the anterior abdominal wall incisions. This study investigated whether subcostal transversus abdominis (STA) block was superior to traditional port-site infiltration of local anesthetic in reducing postoperative pain, opioid consumption, and time for recovery. Materials and Methods: Forty-three patients presenting for day case laparoscopic cholecystectomy were randomly allocated to receive either an ultrasound-guided STA block (n = 21) or port-site infiltration of local anesthetic (n = 22). Visual analog pain scores were measured at 1 and 4 h postoperatively to assess pain severity, and opioid requirement was measured in recovery and up to 8 h postoperatively. The time to discharge from recovery was recorded. Results: STA block resulted in a significant reduction in serial visual pain analog score values and significantly reduced the fentanyl requirement in recovery by >35% compared to the group that received local port-site infiltration (median 0.9 vs. 1.5 ?cg/kg). Furthermore, STA block was associated with nearly a 50% reduction in overall 8-h equivalent morphine consumption (median 10 mg vs. 19 mg). In addition, STA block significantly reduced median time to discharge from recovery from 110 to 65 min. Conclusion: The results suggest that STA block provides superior postoperative analgesia and reduces opioid requirement following laparoscopic cholecystectomy. It may also improve theater efficiency by reducing time to discharge from the recovery unit.

Tolchard, S; Davies, R; Martindale, S

2012-01-01

168

Oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy: A comparative evaluation  

PubMed Central

Background: Hemodynamic responses of laryngoscopy and laparoscopy should be attenuated by the appropriate premedication, smooth induction, and rapid intubation. The present study evaluated the clinical efficacy of oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy. Methods: A total of 180 healthy adult consented patients aged 35 to 52 years with American Society of Anesthesiologist (ASA) physical status I and II of both gender, who met the inclusion criteria for elective laparoscopic cholecystectomy, were randomized to receive placebo Group I, pregabalin (150 mg) Group II, or clonidine (200 ?g) Group III, given 75 to 90 minutes before surgery as oral premedication. All groups were compared for preoperative sedation and anxiety level along with changes of heart rate and mean arterial pressure prior to premedication, before induction, after laryngoscopy, pneumoperitoneum, release of carbon dioxide, and extubation. Intraoperative analgesic drug requirement and any postoperative complications were also recorded. Results: Pregabalin and clonidine proved to have sedative and anxiolytic effects as oral premedicants and decreased the need of intraoperative analgesic drug requirement. Clonidine was superior to pregabalin for attenuation of the hemodynamic responses to laryngoscopy and laparoscopy, but it increased the incidence of intra-and postoperative bradycardia. No significant differences in the parameters of recovery were observed between the groups. None of the premedicated patient has suffered from any postoperative side effects. Conclusion: Oral premedication with pregabalin 150 mg or clonidine 200 ?g causes sedation and anxiolysis with hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy, without prolongation of recovery time and side effects.

Gupta, Kumkum; Sharma, Deepak; Gupta, Prashant K.

2011-01-01

169

Surgical options in the management of cystic duct avulsion during laparoscopic cholecystectomy  

PubMed Central

Background Avulsion of cystic duct during laparoscopic cholecystectomy (LC) is not a common intraoperative complication, but may be encountered by any laparoscopic surgeon. Surgeons are rarely familiar with management of this condition. Methods Patients with gall stone related problems who were scheduled for LC at the minimal invasive surgery unit of a tertiary referral hospital during a 5 years period (April 2002–April 2007) were prospectively enrolled. Results 12 cases were identified (incidence: 1.15%). All 12 patients had gallbladder inflammation. Five patients had acute and seven patients had chronic cholecystitis. The avulsed cystic duct (ACD) was managed by clipping in 4, intracorporeal suturing in 3, converting to open surgery with suture ligation in 2, and lonely external drainage in 3 patients. Bile leakage had ceased within 3 days in 2, 14 days in one, and 20 days in the other patient. Bile volume increased gradually in one of the patients, which stopped only after endoscopic sphincterotomy (ES) at 25th postoperative day. No major late complication or mortality occurred. Conclusion ACD during LC is a rare complication. Almost all standard methods of treatment yield to successful outcomes with low morbidity. According to the situation, ACD may be successfully managed laparoscopically. Available cystic stump remnant was clipped. Intracorporeal suture ligation was performed when short length of stump precluded clipping. Deeply retracted cystic duct with active bile leak led to conversion to open surgery. With minimal or no bile leak at ACD stump, closed tube drainage of sub-hepatic area was attempted. Persistent bile leak was assumed to be controlled by ES, successfully accomplished in one patient.

Karimian, Faramarz; Aminian, Ali; Mirsharifi, Rasoul; Mehrkhani, Farhad

2008-01-01

170

The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum  

Microsoft Academic Search

Background: This study was undertaken to investigate operating room performance of surgical residents, after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course. This course is the first formal surgical resident trainings course, using a variety of complementary virtual reality (VR) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy. The course was granted

M. P. Schijven; J. J. Jakimowicz; I. A. M. J. Broeders; L. N. L. Tseng

2005-01-01

171

Laparoscopic cholecystectomy delayed by complicated myocardial infarction with papillary muscle rupture, and performed after unique complex mitral repair  

PubMed Central

A 65-year-old woman was admitted for laparoscopic cholecystectomy, a method of choice for gallbladder diseases. Symptoms of gallstones are similar to angina pectoris, especially in right coronary artery stenosis. In this case, masked by known symptomatic gallstones, unsuspected coronary artery disease manifested with complicated myocardial infarction and pulmonary edema. The patient survived the acute period, treated pharmacologically. Severe mitral insufficiency caused mainly by ruptured papillary muscle, with left ventricle and atrium enlargement, and right coronary artery stenosis were indications for heart surgery. Repair of this infrequent complication of myocardial infarction is rarely feasible. The complex repair, unique for this cause, is described. During the operation, the head of the ruptured posteromedial papillary muscle was re-implanted, and two neo-chords implanted for prolapsing the A2 mitral valve segment. Annuloplasty with a 29 mm elastic ring accomplished repair. Saphenous bypass graft was applied to the only feasible postero-lateral branch. Although intraoperative echocardiography revealed excellent results, inotropic support, and intra-aortic counterpulsation were necessary for weaning off cardio-pulmonary bypass and low cardiac output treatment. The patient was discharged home on postoperative day 12, with anticoagulant administered for 3 months. As soon as it was no longer required, she underwent laparoscopic cholecystectomy, with no complications. Durable results of both operations performed 5 years ago are confirmed by physical examination and ultrasonography. Complex mitral valve repair, rather than valve replacement, should be considered in similar cases. Possibility of coexistence of coronary artery disease should be considered before cholecystectomy. Good quality repair of cardiac disease allows for laparoscopic cholecystectomy.

Jaszewski, Ryszard; Jander, Slawomir; Maciejewski, Marek

2013-01-01

172

Early Laparoscopic Cholecystectomy Service Provision is Feasible and Safe in the Current UK National Health Service  

PubMed Central

INTRODUCTION Despite increasing evidence of the benefits and safety of early laparoscopic cholecystectomy (LC) in acute gallstone disease, it is not widely practised in England. The Royal College of Surgeons of England support the separation of emergency and elective surgical care. The aim of this prospective study was to examine the impact of the implementation of ‘Surgeon of the Week (SoW)’ model on the number of early LCs performed and the efficiency of the emergency theatre activity in our hospital. This study also looked into its implications on specialist registrar training for early LC, and the financial impact to the hospital. PATIENTS AND METHODS Between January 2007 and May 2008, demographic data, admission and discharge dates, complications, conversions to an open operation and deaths were collected for all patients who underwent early laparoscopic cholecystectomies. For ease of comparison, patients were divided into Group A representing before introduction of SoW (1 January 2007 to 30 August 2007) and Group B representing after introduction of SoW (1 October 2007 to 31 May 2008). The total numbers of operations performed in the emergency theatre list in the two groups were also calculated. RESULTS A total of 1361 emergency operations were performed on the emergency theatre list in Group A, of which 951 were general surgical procedures. In Group B, the numbers of emergency procedures were 1537, of which 1138 were general surgical operations. There was a significant increase in the number of general surgical operations after introduction of SoW (P = 0.013). Before introduction of the SoW rota, 45 early LCs were performed. This increased to 118 after SoW which was significant (P < 0.001). In Group A, the number of early LCs performed by surgical trainees was 10 (22%). In Group B, the number of LCs performed by surgical trainees was 35 (30%; not significant). CONCLUSIONS This study has demonstrated an increase in the efficiency of the emergency theatre with an increase in the number of early LCs on their index admission without extra morbidity following implementation of the SOW model in our hospital. We recommend the introduction of a suitable emergency surgical consultant on-call model separating emergency and elective surgical care depending on local circumstances. This can lead to significant cost savings and reduce re-admissions with gallstone-related complications.

Agrawal, S; Battula, N; Barraclough, L; Durkin, D; Cheruvu, CVN

2009-01-01

173

Abdominal Wall Lift Versus Positive-Pressure Capnoperitoneum for Laparoscopic Cholecystectomy  

PubMed Central

Objective: To compare intraoperative cardiac function, postoperative cognitive recovery, and surgical performance of laparoscopic cholecystectomy with abdominal wall lift (AWL) versus positive-pressure capnoperitoneum (PPCpn). Summary Background Data: AWL has been proposed as an alternative approach to PPCpn to avoid adverse cardio-respiratory changes. However, the workspace obtained with the AWL is less optimal than PPCpn and previous studies documenting delayed postoperative recovery of consciousness following PPCpn have not assessed mental alertness despite its importance. Methods: Forty operations were randomized into AWL and PPCpn. A standard anesthetic protocol was followed. Cardiac indices were measured with an esophageal Doppler machine. An auditory vigilance test was used to measure alertness level following extubation. All operations were videotaped and human reliability assessment techniques were used to identify surgical errors. Results: There was a significant reduction in cardiac output during the first 20 minutes following CO2 insufflation in the PPCpn group, whereas in the AWL group it did not exhibit any significant change. Patients in AWL arm had better vigilance scores at 90 and 180 minutes following extubation compared with the PPn group (P < 0.05). Significantly more surgical errors were observed during surgery with AWL than with PPCpn (7.1 ± 1.1; versus 2.9 ± 0.4; P = 0.001). Conclusions: The AWL approach avoids fall in cardiac output associated with PPCpn during laparoscopic surgery and is associated with a more rapid recovery of postoperative cognitive function compared with PPCpn. However, AWL increases the level of difficulty in the execution of the operation.

Alijani, Afshin; Hanna, George B.; Cuschieri, Alfred

2004-01-01

174

Control of port-site bleeding from smaller incisions after laparoscopic cholecystectomy surgery: a new, innovative, and easier technique.  

PubMed

Laparoscopic cholecystectomy has become the standard of care for patients with acute cholecystitis, symptomatic cholelithiasis, and biliary dyskinesia. Most surgeons now perform this procedure as outpatient surgery. In a standard laparoscopic cholecystectomy procedure, three trocar incisions are made outside the umbilicus. Stopping the bleeding from these port sites can be problematic because of the small size of the incision and the fact that these bleeding points are situated deep in the incision. This is especially true in obese patients and patients taking Asprin or Plavix and undergoing emergency cholecystectomy. In these circumstances, control of the bleeding requires either enlargement of the incision or placement of deep sutures, leading to an ugly scar. We present a simple and innovative technique for controlling port-site bleeding, which involves plugging the port-site hole with Surgicel (Johnson & Johnson Medical, Inc., Arlington, Texas). Our experience with 20 patients to date has shown wound healing to be excellent, with no complications such as hematoma or infection. PMID:12193814

Rastogi, Vijay; Dy, Victor

2002-08-01

175

Complications of laparoscopic cholecystectomy and its prevention: a review and experience of 400 cases.  

PubMed

In the present era laparoscopic cholecystectomy (LC) has become the gold standard treatment of choice for gallstone disease. This technique has made a new revolution in minimal invasive surgery, but also the spectrum of complications has changed. In this paper we shared our personal experience of LC in 400 hundred cases from January 2007 to December 2010, its complications and prevention. According to our experience the complications were liver bed injury (n=32, 8%), spilled gall stones (n=29, 7.25%), port site infection (n=11, 2.75%), vascular injury (n=18, 4.5%), conversion to open surgery (n=16, 4%), biliary leak (n=10, 2.5%), bowel injury (n=3, 0.75%), CBD stricture (n=4, 1%) and umbilical port hernia (n=2, 0.5%). Before the procedure, patient consent and awareness to all possible complications which may occur intra-operatively is very important. A good surgical team and experience in this procedure seems to prevent hazardous complications. PMID:22260821

Yi, Feng; Jin, Wen-Sheng; Xiang, De-Bing; Sun, Gui-Yin; Huaguo, Dai

176

Comparison of hemodynamic and metabolic stress responses caused by endotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy  

PubMed Central

Background: We aimed to compare hemodynamic and endocrine alterations caused by stress response due to Proseal laryngeal mask airway and endotracheal tube usage in laparoscopic cholecystectomy. Materials and Methods: Sixty-three ASA I-II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into two groups of endotracheal tube and Proseal laryngeal mask airway. Standard general anaesthesia was performed in both groups with the same drugs in induction and maintenance of anaesthesia. After anaesthesia induction and 20 minutes after CO2 insufflations, venous blood samples were obtained for measuring adrenalin, noradrenalin, dopamine and cortisol levels. Hemodynamic and respiratory parameters were recorded at the 1st, 5th, 15th, 30th and 45th minutes after the insertion of airway devices. Results: No statistically significant differences in age, body mass index, gender, ASA physical status, and operation time were found between the groups (p > 0.05). Changes in hemodynamic and respiratory parameters were not statistically significant when compared between and within groups (p > 0.05). Although no statistically significant differences were observed between and within groups when adrenalin, noradrenalin and dopamine values were compared, serum cortisol levels after CO2 insufflation in PLMA group were significantly lower than the ETT group (p = 0.024). When serum cortisol levels were compared within groups, cortisol levels 20 minutes after CO2 insufflation were significantly higher (46.1 (9.5-175.7) and 27.0 (8.3-119.4) in the ETT and PLMA groups, respectively) than cortisol levels after anaesthesia induction (11.3 (2.8-92.5) and 16.6 (4.4-45.4) in the ETT and PLMA groups, respectively) in both groups (p = 0.001). Conclusion: PLMA usage is a suitable, effective and safe alternative to ETT in laparoscopic cholecystectomy patients with lower metabolic stress.

Gulec, Handan; Cakan, Turkay; Yaman, Halil; Kilinc, Aytul Sadan; Basar, Hulya

2012-01-01

177

Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial  

PubMed Central

Background Ultrasonic dissection has been suggested as an alternative to monopolar electrocautery in laparoscopic cholecystectomy because it generates less tissue damage and may have a lower incidence of gallbladder perforation. We compared the 2 methods to determine the incidence of gallbladder perforation and its intraoperative consequences. Methods We conducted a prospective randomized controlled trial between July 2008 and December 2009 involving adult patients with symptomatic gall stone disease who were eligible for laparoscopic cholecystectomy. Patients were randomly assigned before administration of anesthesia to electrocautery or ultrasonic dissection. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stones spillage, lens cleaning, duration of surgery and estimation of risk of gall-bladder in the presence of complicating factors. Results We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, previous abdominal surgeries, preoperative ultrasonography findings and intraoperative complications. The overall incidence of gallbladder perforation was 28.3% (40.0% in the electrocautery v. 16.7% in the ultrasonic dissection group, p = 0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in ultrasonic group (p = 0.045). Lens cleaning time (p = 0.015) and duration of surgery (p = 0.001) were longer in the electrocautery than the ultrasonic dissection group. There was no statistical difference in stone spillage between the groups (p = 0.62). Conclusion Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.

Mahabaleshwar, Varun; Kaman, Lileswar; Iqbal, Javid; Singh, Rajinder

2012-01-01

178

Physiologic effects of pneumoperitoneum in adults with sickle cell disease undergoing laparoscopic cholecystectomy (A case control study)  

Microsoft Academic Search

Background  Many studies have demonstrated the adverse consequences of pneumoperitoneum. However, few studies have examined the physiologic\\u000a effects of pneumoperitoneum in adults with sickle cell disease (SCD) during laparoscopic cholecystectomy (LC).\\u000a \\u000a \\u000a \\u000a Methods  60 ASA 1-?\\u000a ? patients, with cholelithiasis, scheduled for elective LC were allocated into two equal groups: group 1, normal patients\\u000a without SCD (control group), and group 2, patients with

Mohamed A. M. Youssef; Abdulrahman Al Mulhim

2008-01-01

179

Comparisons of Prediction Models of Quality of Life after Laparoscopic Cholecystectomy: A Longitudinal Prospective Study  

PubMed Central

Background Few studies of laparoscopic cholecystectomy (LC) outcome have used longitudinal data for more than two years. Moreover, no studies have considered group differences in factors other than outcome such as age and nonsurgical treatment. Additionally, almost all published articles agree that the essential issue of the internal validity (reproducibility) of the artificial neural network (ANN), support vector machine (SVM), Gaussian process regression (GPR) and multiple linear regression (MLR) models has not been adequately addressed. This study proposed to validate the use of these models for predicting quality of life (QOL) after LC and to compare the predictive capability of ANNs with that of SVM, GPR and MLR. Methodology/Principal Findings A total of 400 LC patients completed the SF-36 and the Gastrointestinal Quality of Life Index at baseline and at 2 years postoperatively. The criteria for evaluating the accuracy of the system models were mean square error (MSE) and mean absolute percentage error (MAPE). A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and to rank the variables in order of importance. Compared to SVM, GPR and MLR models, the ANN model generally had smaller MSE and MAPE values in the training data set and test data set. Most ANN models had MAPE values ranging from 4.20% to 8.60%, and most had high prediction accuracy. The global sensitivity analysis also showed that preoperative functional status was the best parameter for predicting QOL after LC. Conclusions/Significance Compared with SVM, GPR and MLR models, the ANN model in this study was more accurate in predicting patient-reported QOL and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.

Shi, Hon-Yi; Lee, Hao-Hsien; Tsai, Jinn-Tsong; Ho, Wen-Hsien; Chen, Chieh-Fan

2012-01-01

180

Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly  

PubMed Central

AIM: To evaluate the outcome of laparoscopic cholecystectomy (LC) in patients aged 80 years and older. METHODS: A total of 353 patients aged 65 to 79 years (group 1) and 35 patients aged 80 years and older (group 2) underwent LC. Patients were further classified into two other groups: those with uncomplicated gallbladder disease (group A) or those with complicated gallbladder disease (group B). RESULTS: There were no significant differences between the age groups (groups 1 and 2) with respect to clinical characteristics such as age, gender, comorbid disease, or disease presentation. Mean operative time, conversion rate, and the incidence of major postoperative complications were similar in groups 1 and 2. However, the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0% vs 5.7%, P < 0.01). Group A comprised 322 patients with a mean age of 71.0 ± 5.3 years, and group B comprised 51 patients with a mean age of 69.9 ± 4.8 years. In group B, mean operative time (78.4 ± 49.3 min vs 58.3 ± 35.8 min, P < 0.01), mean postoperative hospital stay (7.9 ± 6.5 d vs 5.0 ± 3.7 d, P < 0.01), and the incidence of major postoperative complications (9.8% vs 3.1%, P < 0.05) were significantly greater than in group A. The conversion rate tended to be higher in group B, but this difference was not significant. CONCLUSION: Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease, and not by chronologic age. In octogenarians, LC should be performed at an earlier, uncomplicated stage of the disease whenever possible to improve perioperative outcomes.

Kim, Hyung Ook; Yun, Jung Won; Shin, Jun Ho; Hwang, Sang Il; Cho, Yong Kyun; Son, Byung Ho; Yoo, Chang Hak; Park, Yong Lai; Kim, Hungdai

2009-01-01

181

Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy during the same session: Feasibility and safety  

PubMed Central

AIM: To explore the feasibility and safety of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy (LC) performed during the same session. METHODS: Between July 2010 and May 2013, 156 patients with gallstones and common bile duct (CBD) stones were enrolled in this retrospective study. According to the sequence of endoscopic procedures and LC, patients were classified into two groups: in group 1, patients underwent endoscopic stone extraction and LC during the same session, and in group 2, patients underwent LC at least 3 d after endoscopic stone extraction. Outcomes of the endoscopic procedures and LC were compared between the two groups, respectively. RESULTS: There were 91 patients in group 1 and 65 patients in group 2. The characteristics of the two groups were similar. The mean duration of the endoscopic procedures was 34.9 min in group 1 and 35.3 min in group 2. There were no significant differences in the success rate of the endoscopic procedures (97.8% for group 1 vs 98.5% for group 2), the total rate of endoscopic complications (4.40% for group 1 vs 4.62% for group 2) and CBD stone clearance rate (96.7% for group 1 vs 96.9% for group 2). Duration of LC was 53.6 min in group 1 and 52.8 min in group 2. There were no significant differences in the overall LC-related morbidity and postoperative hospital stay. CONCLUSION: Endoscopic stone extraction and LC performed during the same session was feasible and safe in patients with gallstones and concomitant CBD stones.

Zang, Jin-Feng; Zhang, Chi; Gao, Jun-Ye

2013-01-01

182

Day case Laparoscopic Cholecystectomy: experience at the Bangabandhu Sheikh Mujib Medical University.  

PubMed

Day case surgery offers convenience to the patients and cost saving to the healthcare institutes. In this prospective study, the authors reviewed their experience with day case Laparoscopic Cholecystectomy (LC) to determine its outcome in the government healthcare settings of Bangladesh. Selection criteria's for the day case LC were patients with symptomatic cholelithiasis with ASA (American Society of anesthesiologists) grade I or II, the availability of a responsible carer, absence of morbid obesity, low risk for concomitant presence of bile duct stones and domicile within Dhaka and around. Patients were admitted in the post operative ward as day case (DC) in the morning and were discharged on the next morning with a standard analgesia. Two hundred ten patients were admitted for LC as day cases over the last 7 years from October 2003 to October 2010 on the morning operation theatre lists. Five patients later required admission to the inpatient department for conversion to the open procedure. None of the patients was readmitted after discharge. Majority patients were followed up after 1st and 6th week. Two hundred seven patients attended for the follow up at the 1st week and 158 patients were reported for the 6th week. One hundred ninety six patients resumed their normal job or activities after one week. Patient's satisfaction was assessed by questionnaires. Two hundred five patients were either satisfied or very satisfied with the day-case procedure. It appears that for selected groups of patients, day-case LC can be safely done in government healthcare settings of Bangladesh with good patient satisfaction. PMID:22828548

Khan, M H; Khan, A W; Aziz, M M; Rabbi, M A

2012-07-01

183

Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis  

Microsoft Academic Search

Background: The ultimate therapy for acute cholecystitis is cholecystectomy. However, in critically ill elderly patients the mortality of emergency cholecystectomy may reach up to 30%. Open cholecystostomy performed under local anesthesia was considered to be the procedure of choice for treatment of acute cholecystitis in high-risk patients. In recent years, ultrasound- or computed tomography (CT)-guided percutaneous transhepatic cholecystostomy (PTHC) replaced

Ram M Spira; Aviran Nissan; Oded Zamir; Tzeela Cohen; Scott I Fields; Herbert R Freund

2002-01-01

184

Transvaginal single-port natural orifice transluminal endoscopic surgery for benign uterine adnexal pathologies.  

PubMed

Transvaginal natural orifice transluminal endoscopic surgery (NOTES) with pneumoperitoneum has been used in cholecystectomies, appendectomies, and nephrectomies, but transvaginal NOTES using a single port in gynecologic procedures has not been described despite gynecologist familiarity with the vaginal approach. We performed transvaginal single-port NOTES in 10 women with benign uterine adnexal disease: oophorectomy in 3 patients, salpingostomy and salpingectomy in 2 each, and ovarian cystectomy, paratubal cystectomy, and ovarian wedge resection in 1 each. The patients were discharged at 1 or 2 days postoperatively, and were satisfied, with minimal pain, no abdominal scar, and no complications at 2-month follow-up. We conclude that transvaginal single-port NOTES to treat benign uterine adnexal disease is a feasible and attractive option. PMID:22763314

Ahn, Ki Hoon; Song, Jae Yun; Kim, Sun Haeng; Lee, Kyu Wan; Kim, Tak

2012-07-03

185

SILS cholecystectomy, early experience of a single institution: pilot study of 21 cases.  

PubMed

Many surgeons have attempted to reduce the number and the size of ports in laparoscopic cholecystectomy to decrease parietal trauma and pain, and to improve cosmetic results. We report a series of laparoscopic cholecystectomies using a single-port technique (SILS) through an umbilical incision in a pilot group of 21 cases. Our goal was to validate and develop the single-port access as a viable option. All the operations were performed using an umbilical SILS port (Ethicon). Most reported techniques utilize special purpose-made instruments. This article provides a stepwise description of the procedure using all straight instruments. No special reticulating instruments or flexible telescopes were used. We report our early difficulties and concerns about the procedure and propose solutions to the problems. Patients' request for improved cosmesis impels surgeons toward the application of SILS, but the true advantage of the technique should be assessed by more evidences. For this reason, we are planning a single-institution, prospective randomized controlled trial to compare postoperative pain, operating time and cosmetic result between one port and standard laparoscopic surgery. PMID:22539094

Ruffo, G; Barugola, G; Scopelliti, F; Sartori, A; Crippa, S; Partelli, S; Falconi, M

2012-04-27

186

Transanal single-port low anterior resection in a cadaver model  

Microsoft Academic Search

Background  Natural orifice transluminal endoscopic surgery (NOTES), a recent development in the field of minimally invasive surgery,\\u000a provides theoretical advantages over open and laparoscopic surgery. Challenges with the use of NOTES for colon resections\\u000a include the need to extract a large specimen and perform an intestinal anastomosis. A transanal single-port laparoscopic proctectomy\\u000a uses the potential advantages of NOTES yet provides easy

Alyssa D. Fajardo; Steven R. Hunt; James W. Fleshman; Matthew G. Mutch

2010-01-01

187

The comparative evaluation of intravenous with intramuscular clonidine for suppression of hemodynamic changes in laparoscopic cholecystectomy  

PubMed Central

Background: Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. The aim of this study was to compare intravenous (IV) clonidine (2 ?g/kg) with intramuscular (IM) clonidine (2 ?g/kg) for attenuation of stress response in laproscopic surgeries. Methods: Eighty adult patients classified as ASA physical status I or II, aged between 20 and 60 years undergoing elective cholecystectomy under general anesthesia were enrolled for a prospective, randomized, and double-blind controlled trial. They received either IV clonidine (2 ?g/kg) 15 min prior to the scheduled surgery (Group I) or IM clonidine (2 ?g/kg) 60-90 min prior to the scheduled surgery (Group II). Hemodynamic variables (Heart rate, systolic (SBP), diastolic (DBP), mean arterial pressure (MAP)), SpO2 and EtCO2 were recorded at specific times - baseline, prior to induction, 1 min after intubation, before CO2, insufflation, after CO2 insufflation at 1,5,10,20,30,45,60 min, after release of CO2, at 1 and 10 minutes after extubation. Secondary outcomes included evaluation of adverse effect profile of the two groups. Results: No significant difference was observed in the HR throughout the intraoperative period in between the two groups (P>0.05). There was statistically significant difference in SBP between the two groups starting from 1 minute after induction till 1 min after extubation (P<0.05) but not in DBP except at 1 minute after intubation (P=0.042). Significant difference in MAP was noted at 1 minute after intubation (P=0.004) and then from 5 minutes after CO2 insufflation to 1 minute after extubation (P<0.05). Incidence of adverse effects were higher in group II (P=0.02) especially incidence of hypertension requiring treatment (0.006). Conclusion: We conclude that under the conditions of this study, hemodynamic parameters (SBP, DBP and MAP) were better maintained in the IV as compared to the IM route that had significantly higher incidence of hypertension requiring treatment.

Singh, Meena; Choudhury, Arin; Kaur, Manpreet; Liddle, Dootika; Verghese, Mary; Balakrishnan, Ira

2013-01-01

188

Laparoscopic cholecystectomy under field conditions in Asiatic black bears (Ursus thibetanus) rescued from illegal bile farming in Vietnam.  

PubMed

Nine adult Asiatic black bears (Ursus thibetanus) previously rescued from illegal bile farming in Vietnam were examined via abdominal ultrasound and exploratory laparoscopy for liver and gall bladder pathology. Three bears demonstrated notable gall bladder pathology, and minimally invasive cholecystectomies were performed using an open laparoscopic access approach, standard 10 to 12 mmHg carbon dioxide pneumoperitoneum and a four-port technique. A single bear required insertion of an additional 5 mm port and use of a flexible liver retractor due to the presence of extensive adhesions between the gall bladder and quadrate and left and right medial liver lobes. The cystic duct was dissected free and this and the cystic artery were ligated by means of extracorporeal tied Meltzer knot sutures. The gall bladder was dissected free of the liver by blunt and sharp dissection, aided by 3.8 MHz monopolar radiosurgery. Bears that have had open abdominal cholecystectomies are reported as taking four to six weeks before a return to normal activity postoperatively. In contrast, these bears demonstrated rapid unremarkable healing, and were allowed unrestricted access to outside enclosures to climb trees, swim and interact normally with other bears within seven days of surgery. PMID:21900258

Pizzi, R; Cracknell, J; David, S; Laughlin, D; Broadis, N; Rouffignac, M; Duong, D V; Girling, S; Hunt, M

2011-09-06

189

The use of single port surgery for polyps located in the rectum.  

PubMed

Transanal endoscopic microsurgery is a minimally invasive technique for the treatment of rectal lesions which was introduced by Buess. In this report the first clinical experience of transanal endoscopic surgery was performed by a single incision laparoscopic surgical port adapted through the anal canal. In single port surgery, the single incision laparoscopic surgical port has to be stitched around anal orifice. There is no need to use a fixation apparatus. In transanal endoscopic microsurgery procedure, a rigid rectoscope 40 mm in diameter is introduced into the anus by stretching anal sphincter. A single incision laparoscopic surgical port can be disposed through the anal canal where there is no harmful cause because it is made an elastic. The dissection in the transanal endoscopic microsurgery procedure needs specific equipment to improve the surgery; however we could complete the surgical dissection using standard laparoscopic devices with articulated ones. The other factor makes single port surgery easier than transanal endoscopic microsurgery procedure is insufflation. It is easy and controlled way to be insufflated by a particular pump and cheaper than any insufflators. Furthermore, in the operating room, the patient's position on the table was not a limiting factor. As a conclusion, we report that for selected patients, single port surgery can be performed using a single incision laparoscopic surgical port as an adjusted surgical technique. It gives safe and feasible way to remove benign and malign polyps and tumors up to 20 cm in the rectum. PMID:22505383

Dem?rba?, Sezai; Cet?ner, Sadettin; Ozer, Tahir M; Ozta?, Muharrem; Duran, Eyüp

2012-02-01

190

Single-port splenectomy: Current update and controversies  

PubMed Central

Multiport laparoscopic splenectomy (LS) is considered the “gold standard” for the management of surgical diseases in normal or slightly enlarged spleens. The concept of minimal-invasive surgical techniques has progressed since the early 1990s from standard multiport laparoscopy to natural orifice transluminal endoscopic surgery (NOTES) and, more recently, to single-port access (SPA). In this paper, we describe our technique for SPA splenectomy and provide a critical review of the current literature on SPA for splenic diseases.Preliminary results published to date indicate that the spleen can be safely removed using single-incision surgery and all the authors have unanimously endorsed the feasibility of this approach. However, available evidence is still scarce. It is based only on case reports and one small series, with a total of 17 patents and, therefore, firm conclusions cannot yet be drawn and more experience and comparative trials are needed to determine the exact role of this interesting new approach.

Targarona, Eduardo M; Lima, Maria B; Balague, Carmen; Trias, Manuel

2011-01-01

191

Effectiveness for pain after laparoscopic cholecystectomy of 0.5% bupivacaine-soaked Tabotamp ® placed in the gallbladder bed: a prospective, randomized, clinical trial  

Microsoft Academic Search

Background  Some scientific studies, with controversial results, have evaluated the efficacy in reducing pain of some different local\\u000a anesthetic molecules, which were administered at different dosages and in different ways. The primary goal of this randomized,\\u000a controlled, prospective study (Clinical Trials.gov ID NCT00599144) was to assess the effectiveness of 0.5% bupivacaine for\\u000a pain control after video-laparoscopic cholecystectomy at its optimal dosage

Francesco Feroci; Katrin Christel Kröning; Marco Scatizzi

2009-01-01

192

Training for laparoscopic surgery  

Microsoft Academic Search

Laparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of

Karl A. Zucker; Robert W. Bailey; Scott M. Graham; William Scovil; Anthony L. Imbembo

1993-01-01

193

Laparoscopic Cholecystectomy in Patients With Situs Inversus Totalis: Literature Review of Two Patients  

PubMed Central

Situs inversus totalis is a rare condition, which presents difficulties in diagnosis and treatment of gallstones due to the reversal location of abdominal organs. In this article we present 2 cases of women in age of 51 and 55 years with situs inversus totalis and gallstones. There are described the clinical and imaging features, also the laparoscopic surgery with the difficulties encountered by right handed surgeon. In patients with situs inversus totalis, laparoscopic surgery may be performed safely by a surgeon with experience.

Demiryilmaz, Ismail; Yilmaz, Ismayil; Albayrak, Yavuz; Peker, Kemal; Sahin, Atalay; Sekban, Nurdan

2012-01-01

194

Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients  

Microsoft Academic Search

Background  Laparoscopic common bile duct (CBD) exploration is a well-established treatment option in dedicated centers. However, few\\u000a data are available on the results in elderly patients.\\u000a \\u000a \\u000a \\u000a Methods  The outcome after laparoscopic CBD exploration in elderly patients (age>-70 years) was compared with that in a concurrent\\u000a control group of younger patients (age <70 years).\\u000a \\u000a \\u000a \\u000a Results  There were 77 elderly patients in group A and

A. M. Paganini; F. Feliciotti; M. Guerrieri; A. Tamburini; R. Campagnacci; E. Lezoche

2002-01-01

195

[Gasless laparoscopic cholecystectomy. Our experience with 130 cases compared with 450 cases treated with the CO2 technique].  

PubMed

Alongside the technique based on the creation of an abdominal cavity for surgery following the introduction of gas (usually CO2) into the peritoneal cavity, a new method has been developed. This involves the use of an atraumatic mechanical lifting device connected to the same abdominal wall (gasless laparoscopy). The authors report a technique that uses an inflatable cushion inserted into the abdomen through a periumbilical incision. The cushion is connected to an external motorized hydraulic jack fixed to the operating table, fitted with an electric motor and friction gear. Between May 1991 and June 1998, 580 patients underwent laparoscopic cholecystectomy. Since December 1995 a total of 130 patients have undergone surgery using gasless laparoscopy. Shoulder pain and pain in the upper abdominal quadrant were no longer reported; pain was present in 70% of the patients operated using the CO2 technique. There was also a marked reduction in the anesthesiological risks, above all in elderly patients with cardiopulmonary insufficiency. Surgical manoeuvres are made easier owing to the possibility of using traditional surgical instruments. Washing and continuous aspiration allow a good control of intraoperative hemostasis, and reduce the phenomenon of lens misting without the risk of losing pneumoperitoneum. Less visibility of the surgical field was reported, particularly in obese patients, above all because of the reduced diaphragmatic distension and the lack of displacement of the intestinal loops. In the authors' opinion the gasless technique is suitable above all in patients affected by cardiopulmonary disorders in whom hypercapnia might represent a significant operating risk. PMID:10859952

Bossuto, E; Bonatti, L; Schieroni, R; Villata, E; Bacino, A; Galliano, R; Lorenzini, L; Borello, G; Butera, F; Massaioli, N

2000-04-01

196

Ambulatory laparoscopic cholecystectomy: An audit of day case vs overnight surgery at a community hospital in Japan  

PubMed Central

AIM: To evaluate the applicability and safety of ambulatory laparoscopic cholecystectomy (LC) and to compare day case and overnight stay LC. METHODS: Data were collected retrospectively and consecutively for day case and overnight stay LC patients from July 1, 2009 to April 30, 2011. Outcomes were analyzed for patient demographics, operation time, blood loss during operation and frequency and reasons for unexpected or prolonged hospitalization in each group. RESULTS: There was no hospital mortality and no patient was readmitted with serious morbidity after discharge. 50 patients received a day case LC and 19 had an overnight stay LC. There was a significant difference in age between both groups (P < 0.02). There were no significant differences between the day case LC performed (n = 41) and failed (n = 9) groups and between the day case LC performed and the one night stay LC (n = 12) groups. There was a significant difference in age between the one night stay and more nights stay LC groups (P < 0.05). Thus, elderly patients showed a tendency to like to stay in hospital rather than being a day case. The proportion of unexpected or prolonged hospitalization was not significantly different between the day case and overnight stay LC groups, when the patient’s request was excluded. CONCLUSION: Day case LC can be performed with a low rate of complications. In overnight stay patients, there are many who could be performed safely as a day case. Moreover, we need to take special care to treat elderly patients.

Sato, Atsushi; Terashita, Yukio; Mori, Yoichiro; Okubo, Tomotaka

2012-01-01

197

Safety and Efficacy of Single-Port Colectomy for Sigmoid Colon Cancer: A Phase II Clinical Trial.  

PubMed

Abstract Background: Recently, single-port surgery for colon cancer has been increasingly attempted. However, prospective studies investigating the efficacy of single-port colectomy for colon cancer are lacking. The aim of this study is to determine whether single-port colectomy for sigmoid colon cancer is a safe and effective surgical option. Subjects and Methods: Forty-eight patients were enrolled for this prospective single-arm Phase II trial. All patients underwent single-port laparoscopic-assisted sigmoidectomy through the umbilicus. The primary outcome was the number of retrieved lymph nodes. Secondary measures included the conversion rate, postoperative morbidities, mortalities, and short-term clinical outcomes. Results: The mean number of retrieved lymph nodes was 21.1 (95% confidence interval, 18.1-23.99). The conversion rate was 14.6% (open conversion, 4.2%), and the overall proportion of morbidity was 31.2%. The majority of complications involved wound problems (18.8%); the mortality rate was 0%. The median postoperative hospital stay was 8 days (range, 7-12 days), and the median time from surgery until the first episode of flatus was 3 days (range, 1-5 days). Conclusions: Single-port colectomy for sigmoid colon cancer is safe and oncologically feasible in selected patients. Considering the relatively high conversion rates, improvement of the instruments for single-port colectomy is needed. PMID:23937142

Park, Ji Won; Sohn, Dea Kyung; Park, Sohee; Park, Sung Chan; Chang, Hee Jin; Son, Hae-Jung; Oh, Jae Hwan

2013-08-12

198

Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy?  

PubMed Central

In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails.

Rabago, Luis R; Ortega, Alejandro; Chico, Inmaculada; Collado, David; Olivares, Ana; Castro, Jose Luis; Quintanilla, Elvira

2011-01-01

199

Changes in gallbladder surgery: Comparative study 4 years before and 4 years after laparoscopic cholecystectomy  

Microsoft Academic Search

Operative procedures on the gallbladder and biliary ducts have undergone a profound transformation since the introduction\\u000a of laparoscopic techniques in general surgery. As the benefits of minimally invasive procedures become universally known,\\u000a patients are seeking surgery at an earlier stage, resulting in an increased number of cases for elective surgery and a considerable\\u000a reduction in emergency operations, morbidity, need for

Jorge Cervantes; Guillermo Rojas; Jorge Anton

1997-01-01

200

A comparison of intravenous-based and epidural-based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy  

Microsoft Academic Search

Purpose  We wished to compare the effectiveness of intravenous-based (IV) and epidural-based (EPI) techniques for anesthesia and postoperative\\u000a analgesia in elderly patients undergoing laparoscopic cholecystectomy. Effectiveness was compared in terms of reduction of\\u000a postoperative pain and adverse events, and achieving a high level of patient satisfaction.\\u000a \\u000a \\u000a \\u000a Methods  Thirty American Society of Anesthesiologists (ASA) physical status I-II patients aged more than 65 years,

Kohki Nishikawa; Saori Kimura; Yuki Shimodate; Motohiko Igarashi; Akiyoshi Namiki

2007-01-01

201

Laparoscopic cholecystectomy due to acute calculous cholecystitis in 16 weeks' in vitro fertilization and embryo transfer pregnancy: report of the first case.  

PubMed

The most common cases of acute abdomen during pregnancy are acute appendicitis followed by acute cholecystitis. The case presented is a 33-year-old patient in 16 weeks' in vitro fertilization and embryo transfer pregnancy who developed acute cholecystitis. Previously there were two unsuccessful cycles, one complicated with ovarian hyperstimulation syndrome. Due to clinical deterioration during intravenous antibiotic therapy laparoscopic cholecystectomy was performed and acute cholecystitis found. The postoperative course was uneventful. During the first 24 h tocolysis with intravenous fenoterol in addition to peroral atenolol 2 ? 50 mg was administered. Postoperative course was uneventful with further normal pregnancy. Elective cesarean section was made in term pregnancy (39 weeks) with singleton with Apgar 10/10. Current guidelines do not recommend prophylactic tocolysis in pregnant population with acute abdomen but there is no mention of the IVF-ET subpopulation of patients. Also, there are no guidelines for thromboprophylaxis in such patients with increased risk of thromboembolic accidents. To our knowledge this is the first case report of a laparoscopic cholecystectomy during IVF-ET gestation. PMID:23298928

Augustin, G; Vrcic, H; Zupancic, B

202

Laparoscopy-assisted distal gastrectomy for early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis: a case report  

PubMed Central

We report our case of laparoscopy-assisted distal gastrectomy with D1 + ? lymph node dissection for a patient with early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis. A superficial elevated lesion was found on the lesser curvature of the antrum. The preoperative diagnosis was cStage IA (cT1, cN0, cH0, cP0, cM0). A 1 cm-sized gallstone was found in the fundus through upper abdominal ultrasound. A laparoscopy-assisted distal gastrectomy with standard D2 lymph node dissection for early gastric cancer and laparoscopic cholecystectomy was successfully performed by not shifting the monitor to the left and right and not changing operator's position without additional blood loss and time. The number of retrieved lymph nodes was 36. We have not found any abnormal course of blood vessels except for the right/left inversion. Billroth I reconstruction was performed through end-to-side anastomosis. Based on a histopathological examination, a 1.5 × 1.5 cm, submucosal (sm3), moderately differentiated adenocarcinoma (pT1, pN0, sH0, sP0, sM0, stage IA) was diagnosed. The postoperative course was favorable and the patient was discharged on postoperative day 7.

Seo, Kyung Won

2011-01-01

203

Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial  

PubMed Central

Background Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice. Methods/Design The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs. Discussion The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients. Trial Registration Netherlands Trial Register (NTR): NTR2666

2012-01-01

204

Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy  

PubMed Central

Objective The objective of the study is to evaluate short-term complications after laparoscopic (LC) or open cholecystectomy (OC) in patients with gallstones by using linked hospital discharge data. Design Population-based cohort study. Setting Data were obtained from the Regional Hospital Discharge Registry Lazio Region in Central Italy (around 5 million inhabitants) in 2007–2008. Participants All patients admitted to hospitals of Lazio with symptomatic gallstones (International Classification of disease, 9th Revision, Clinical Modification (ICD-9-CM)=574) who underwent LC (ICD-9-CM 51.23) or OC (ICD-9-CM 51.22). Outcome measures (1)‘30-day surgical-related complications’ defined as any complication of the biliary tract (including postoperative infection, haemorrhage or haematoma or seroma complicating a procedure, persistent postoperative fistula, perforation of bile duct and disruption of wound). (2) ‘30-day systemic complications’ defined as any complications of other organs (including sepsis, infections from other organs, major cardiovascular events and selected adverse events). Results 13?651 patients were included; 86.1% had LC, 13.9% OC. 2.0% experienced surgical-related complications (SRC), 2.1% systemic complications (SC). The OR of complications after LC versus OC was 0.60 (p<0.001) for SRC and 0.52 (p<0.001) for SC. In relation to SRC, the advantage of LC was consistent across age categories, severity of gallstones and previous upper abdominal surgery, whereas there was no advantage among people with emergency admission (OR=0.94, p=0.764). For SC, no significant advantage of LC was seen among very old people (OR=0.99, p=0.975) and among those with previous upper abdominal surgery (OR=0.86, p=0.905). Conclusions This large observational study confirms that LC is more effective than OC with respect to 30-day complications. Population-based linkage of administrative datasets can enlarge evidence of treatment benefits in clinical practice.

Agabiti, Nera; Stafoggia, Massimo; Davoli, Marina; Fusco, Danilo; Barone, Anna Patrizia; Perucci, Carlo Alberto

2013-01-01

205

Hydrodynamic Classification of Submerged Single-Port Discharges.  

National Technical Information Service (NTIS)

The present classification scheme provides a comprehensive quantitative description of the many possible flow configurations that can occur in single-port, submerged discharges. In our experience, the scheme seems valid for about 95% of practically occurr...

G. H. Jirka R. L. Doneker

1991-01-01

206

Cholecystectomy - Open and Laparoscopic  

MedlinePLUS Videos and Cool Tools

... the shortness of breath, chest pain and possibly death. It is extremely important to let your doctors ... with other operations. These again are very rare. Death may result from these complications but this is ...

207

Laparoscopic cholecystectomy and common bile duct stones. The utility of planned perioperative endoscopic retrograde cholangiography and sphincterotomy: experience with 63 patients.  

PubMed Central

OBJECTIVE: Planned perioperative endoscopic retrograde cholangiography (ERC) and sphincterotomy (ES) for suspected or proven common bile duct stones (CBDS) has been attempted in 63 of 540 consecutive patients undergoing laparoscopic cholecystectomy (LC). Experience with this intervention has been studied with respect to accuracy, efficacy, and safety. SUMMARY BACKGROUND DATA: The optimal management of CBDSs in the era of LC is not defined. Methods exist for the laparoscopic manipulation of the common bile duct; however, experience is limited. Until surgeons become comfortable with this more demanding technique, ERC and ES will have a prominent role in the perioperative management of CBDSs. METHODS: A preoperative group (n = 41) included all candidates for LC with historical, biochemical, or radiologic evidence of CBDSs. A postoperative LC group (n = 22) included patients with stones diagnosed by intraoperative cholangiogram (IOC) (n = 6) or with signs or symptoms of retained, but unproven, CBDSs (n = 16). RESULTS: Thirty-six (88%) of the preoperative attempts were successful. Stones were identified in 18 cases and ES and duct clearance were achieved in all 18. In the postoperative group, ERC was successful in 21 (95%) cases. Calculi were demonstrated in 5 of 6 patients with a positive IOC and 6 of 16 with clinically suspected retained stones. ES and duct clearance were achieved in all 11 patients with documented CBDSs. Overall, ERC was accomplished in 90% of cases. Stones were identified in 51% of cases and all stones were cleared by ES. Morbidity was confined to four cases of self-limited pancreatitis (6%). There were no deaths. CONCLUSIONS: The perioperative management of CBDSs is an appealing approach for patients anticipating the benefits of LC, at least until the laparoscopic manipulation of the common bile duct becomes a more widely accepted technique.

Graham, S M; Flowers, J L; Scott, T R; Bailey, R W; Scovill, W A; Zucker, K A; Imbembo, A L

1993-01-01

208

Robotic single-port transumbilical total hysterectomy: a pilot study  

PubMed Central

Objective To evaluate the feasibility of robotic single-port transumbilical total hysterectomy using a home-made surgical glove port system. Methods We retrospectively reviewed the medical records of patients who underwent robotic single-port transumbilical total hysterectomy between January 2010 and July 2010. All surgical procedures were performed through a single 3-4-cm umbilical incision, with a multi-channel system consisting of a wound retractor, a surgical glove, and two 10/12-mm and two 8 mm trocars. Results Seven patients were treated with robotic single-port transumbilical total hysterectomy. Procedures included total hysterectomy due to benign gynecological disease (n=5), extra-fascial hysterectomy due to carcinoma in situ of the cervix (n=1), and radical hysterectomy due to cervical cancer IB1 (n=1). The median total operative time was 109 minutes (range, 105 to 311 minutes), the median blood loss was 100 mL (range, 10 to 750 mL), and the median weight of the resected uteri was 200 g (range, 40 to 310 g). One benign case was converted to 3-port robotic surgery due to severe pelvic adhesions, and no post-operative complications occurred. Conclusion Robotic single-port transumbilical total hysterectomy is technically feasible in selected patients with gynecological disease. Robotics may enhance surgical skills during single-port transumbilical hysterectomy, especially in patients with gynecologic cancers.

Nam, Eun Ji; Kim, Sang Wun; Lee, Maria; Yim, Ga Won; Paek, Ji Heum; Lee, San Hui; Kim, Sunghoon; Kim, Jae Hoon; Kim, Jae Wook

2011-01-01

209

Cholecystectomy: Surgical Removal of the Gallbladder  

MedlinePLUS

... page is an overview. For more detailed information, review the entire document. Treatment Options Surgery Laparoscopic cholecystectomy — ... evaluation by your surgeon and anesthesia provider to review your health history and medications and to discuss ...

210

Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes  

Microsoft Academic Search

Background  In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision <25 mm) has been increasingly advocated\\u000a for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain,\\u000a shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic\\u000a review was undertaken to evaluate the importance of total size

Rory McCloy; Delia Randall; Stephan A. Schug; Henrik Kehlet; Christian Simanski; Francis Bonnet; Frederic Camu; Barrie Fischer; Girish Joshi; Narinder Rawal; Edmund A. M. Neugebauer

2008-01-01

211

HYDRODYNAMIC CLASSIFICATION OF SUBMERGED SINGLE-PORT DISCHARGES  

EPA Science Inventory

Discharges into ambient water bodies by means of a submerged single-port jet flow can exhibit a great diversity of flow patterns, depending on the geometric and dynamic characteristics of the environment and the discharge flow. igorous classification scheme has been developed--ba...

212

Single Port Electro-Thermal Propulsion-Performance Factors  

NASA Astrophysics Data System (ADS)

Performance models for single port ETP (Electro-Thermal Propulsion) devices are presented considering all significant efficiency factors. Single-port ETP devices, which use the nozzle exit as entrance port for beamed power, are capable of high efficiency and high thrust with low mass penalty for both propellant and structure. Previously considered parabolic nozzle shapes have operated in pulse mode to exchange energy at a concentrated focal region, resulting in low efficiency. The proposed cone/bell shape diffuses the focal region prior to chamber entry to allow continuous combustion inside the chamber with high efficiency. Mechanical and thermal limits are evaluated. For vacuum operation, low chamber pressure operation is possible. Thin wall thruster construction results in low chamber and nozzle mass. Further, at low pressure, regenerative cooling is needed only for the chamber and throat region with radiation cooling for the nozzle exit region. These factors permit high expansion ratio and thrust-to-weight ratio needed for performance.

Johansen, Donald G.

2008-04-01

213

Laparoscopic Approaches to Colonic Malignancy  

Microsoft Academic Search

\\u000a The last two decades have witnessed the surge and success of laparoscopic approaches in several surgical arenas. Laparoscopic\\u000a cholecystectomy, laparoscopic solid organ surgery, and laparoscopic gastric bypass have become the standard of care. Adoption\\u000a of laparoscopic colectomy has remained low until the middle of this decade and is approaching 10% for benign disease [1].\\u000a \\u000a \\u000a Concerns over the appropriateness of laparoscopic

Juliane Bingener; Heidi Nelson

214

Transumbilical Single-Port Surgery: Evolution and Current Status  

Microsoft Academic Search

ContextSingle-port transumbilical laparoscopy, also known as embryonic natural orifice transumbilical endoscopic surgery (E-NOTES), has emerged as an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Within a short span, several clinical reports have emerged in the urologic literature. As this field is poised to move forward, a complete understanding of its evolution and current status

David Canes; Mihir M. Desai; Monish Aron; Georges-Pascal Haber; Raj K. Goel; Robert J. Stein; Jihad H. Kaouk; Inderbir S. Gill

2008-01-01

215

Robotic Liver Resection: Initial Experience With Three-Arm Robotic and Single-Port Robotic Technique  

PubMed Central

Background and Objective: Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. Methods: A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. Results: A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21–68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10–200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Conclusion: Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.

Kandil, Emad; Noureldine, Salem I.; Saggi, Bob

2013-01-01

216

Emergency open cholecystectomy is associated with markedly lower incidence of postoperative nausea and vomiting (PONV) than elective open cholecystectomy: a retrospective cohort study  

Microsoft Academic Search

BACKGROUND: During a previous study to define and compare incidence risks of postoperative nausea and vomiting (PONV) for elective laparoscopic and open cholecystectomy at two hospitals in Jamaica, secondary analysis comparing PONV risk in elective open cholecystectomy to that after emergency open cholecystectomy suggested that it was markedly reduced in the latter group. The decision was made to collect data

Jeffrey M East; Derek IG Mitchell

2010-01-01

217

Comparison of single-port laparoscopy and conventional laparoscopy for extraperitoneal para-aortic lymphadenectomy.  

PubMed

BACKGROUND: Extraperitoneal para-aortic lymphadenectomy (PAL) is used to treat gynecological cancers. This laparoscopic approach was first described using a multiport technique, and more recently, a single-port technique was developed. Our aim was to experimentally compare both approaches-conventional laparoscopy (CL) and single-port laparoscopy (SPL)-via the extraperitoneal laparoscopic approach. METHODS: From November 2006 to July 2012, extraperitoneal PAL was performed by CL or SPL using the GelPOINT device (Applied Medical). The surgical outcomes of the 2 groups were statistically analyzed. RESULTS: The study involved 69 patients; 36 underwent PAL with CL, and 33 patients underwent PAL with SPL. The mean operative times were 211.2 (range, 132-390) min and 159.6 (range, 120-255) min for the CL and SPL groups, respectively. The mean blood loss was not significantly different between the CL (52.5 mL; range, 0-100 mL) and SPL (40.5 mL; range, 0-100 mL, p = 0.62) groups. The average lymph node count was lower in the CL group (11.1; range, 4-29) compared to the SPL group (15; range, 3-19) (p = 0.03). However, this difference was not confirmed in the multivariate analysis (p = 0.16). The mean hospital stay was lower for the SPL group (2.2 days; range, 1-8 days) than the CL group (3.1 days; range, 1-5 days). In this case, the significant difference found in the univariate analysis (p = 0.02) was confirmed by the multivariate analysis (p = 0.0003). There were no conversions to open technique and no major complications. CONCLUSIONS: The SPL method appears to be a feasible approach, with surgical outcomes that are not statistically different from the CL method. The cosmetic aspect, the role of SPL in decreasing postoperative pain, and its impact on hospital stay must be confirmed prospectively in larger series. PMID:23783555

Hudry, Delphine; Cannone, Francesco; Houvenaeghel, Gilles; Buttarelli, Max; Jauffret, Camille; Chéreau, Elisabeth; Lambaudie, Eric

2013-06-20

218

Diffusion of laparoscopic technologies in Denmark  

Microsoft Academic Search

It has been predicted that minimally invasive therapy will have dramatic consequences for the specialty of general surgery, as demonstrated by the diffusion of laparoscopic cholecystectomy. To investigate the determinants of the diffusion in Denmark of five laparoscopic technologies (cholecystectomy, appendicectomy, surgery for colon cancer, surgery for inguinal hernia and fundoplication), questionnaires on seventeen factors' influence on the adoption (stimulating

Peter Bo Poulsen; Sven Adamsen; Hindrik Vondeling; Torben Jørgensen

1998-01-01

219

Imaging findings of biliary and nonbiliary complications following laparoscopic surgery  

Microsoft Academic Search

Laparoscopic techniques are evolving for a wide range of surgical procedures although they were initially confined to cholecystectomy and exploratory laparoscopy. Recently, surgical procedures performed with a laparoscope include splenectomy, adrenalectomy, gastrectomy, and myomectomy. In this article, we review the spectrum of complications and illustrate imaging features of biliary and nonbiliary complications after various laparoscopic surgeries. Biliary complications following laparoscopic

Jin-Young Choi; Myeong-Jin Kim; Mi-Suk Park; Joo Hee Kim; Joon Seok Lim; Young Taik Oh; Ki Whang Kim

2006-01-01

220

Hepatic Evisceration After Cholecystectomy in a Superobese Patient  

Microsoft Academic Search

Gallbladder pathology, in general, and cholelithiasis, in particular, are more common in the morbidly obese. Obesity is a\\u000a risk factor for conversion to open surgery in laparoscopic cholecystectomy. Obesity is also a risk factor for evisceration\\u000a after laparotomy in adults. Hepatic evisceration after cholecystectomy is rare. We describe a case of right liver lobe evisceration\\u000a diagnosed by abdominal computed tomography

José Ignacio Rodríguez-Hermosa; Bartomeu Ruiz-Feliú; Josep Roig-García; Jordi Gironès-Vilà; Pere Planellas-Giné; Pedro Ortuño-Muro; Antoni Codina-Cazador

2008-01-01

221

Hepatic Evisceration After Cholecystectomy in a Superobese Patient  

Microsoft Academic Search

Gallbladder pathology in general and cholelithiasis in particular are more common in the morbidly obese. Obesity is a risk\\u000a factor for conversion to open surgery in laparoscopic cholecystectomy. Obesity is also a risk factor for evisceration after\\u000a laparotomy in adults. Hepatic evisceration after cholecystectomy is rare. We describe a case of right liver lobe evisceration\\u000a diagnosed by abdominal computed tomography

José Ignacio Rodríguez-Hermosa; Bartomeu Ruiz-Feliú; Josep Roig-García; Jordi Gironès-Vilà; Pere Planellas-Giné; Pedro Ortuño-Muro; Antoni Codina-Cazador

2008-01-01

222

Minimally invasive (laparoscopic) surgery  

Microsoft Academic Search

  Minimally invasive (laparoscopic) surgery became a major part of general surgery with the introduction of laparoscopic cholecystectomy\\u000a in the late 1980s. This was the culmination of the development of instruments and techniques by many physicians; Kelling developing\\u000a pneumoperitoneum, Zollikofer using carbon dioxide, Kalk designing a lens system and the dual-trochar technique, Veress using\\u000a the Veress needle to create pneumoperitoneum, Hasson

H. S. Himal

2002-01-01

223

Two-port laparoscopic common bile duct exploration with T-tube choledochostomy for management of choledocholithiasis: an initial clinical report.  

PubMed

Laparoscopic common bile duct exploration (LCBDE) is generally performed using a four- or five-port technique. We report a unique technique of two-port transcholedochal LCBDE with T-tube placement. Twelve consecutive patients with common bile duct (CBD) stones underwent LCBDE through two entry ports, one homemade single port (Uen port) inserted in a 2-cm umbilical wound and one 5-mm subxiphoid trocar port. With the assistance of a 1.2-mm needle that was inserted through a right lower intercostal space into the abdominal cavity to facilitate the operation, two-port dome-down laparoscopic cholecystectomy, choledochotomy, choledochoscopic removal of ductal caculi, and T-tube choldochostomy were performed with conventional methods using standard laparoscopic instruments along with manually operated angled shafts. After completion of the operation, the T-tube catheter was brought out through the subxiphoid trocar wound. All operations were completed successfully without the need of additional ports. There was no complication and no residual stones. Mean operation time was 120 minutes (range, 90 to 150 minutes), and mean postoperative hospital stay was 3.5 days (range, 3 to 4 days). Scarless wound healing was achieved except one T-tube scar. Two-port transumbilical LCBDE with T-tube choledochostomy is a feasible, safe, and effective technique that allows one-scar abdominal surgery for treatment of CBD stones. Further studies and the development of better instruments are necessary before this can be recommended as a standard procedure. PMID:21679549

Sun, Ding-Ping; Wang, Wen-Ching; Wen, Kuo-Chang; Lin, Kai-Yuan; Lin, Yi-Feng; Wen, Kuo-Shan; Uen, Yih-Huei

2011-04-01

224

Informed consent and choice in cholecystectomy.  

PubMed

As patients and parents seek more information and the threat of litigation increases, the process of informed consent has assumed greater importance. Data from large adult experiences indicate that the risk of bile duct injury, although small, is greater with laparoscopic cholecystectomy (LC) than open cholecystectomy. This complication has not yet been documented in pediatric practice, where cholecystectomy is relatively uncommon. What method do parents and patients choose if consent is truly informed? Of 57 consecutive children undergoing cholecystectomy, an open procedure was specifically indicated in 20 (previous major gastrointestinal surgery in 11, concomitant major abdominal operation in four, and complex biliary tract disease in five) and LC in two (cystic fibrosis, severe autism). The remaining 35 patients were counseled in a standard manner about the relative merits of LC versus mini-cholecystectomy (MC) and allowed to choose. Specifically, they were informed that LC offers better cosmesis, less postoperative discomfort, and a shorter hospital stay, but in adults is associated with a slightly increased rate of bile duct injury (0.3-0.5% vs. 0.2%). All MCs were performed through a 4-cm incision. Parents chose LC in 23 cases and MC in 12. The median age of both groups was similar. No surgical complications occurred, and there were no conversions in the LC group. No patient had retained stones. LC patients were discharged home after a mean of 1.7 days and MC patients after 2.3 days (0.1 > p > 0.05). If an open or laparoscopic technique is not specifically indicated and if parents/patients are fully informed, a significant minority may opt for mini-cholecystectomy. PMID:15490193

Stringer, Mark D

2004-10-01

225

Is single port incisionless-intracorporeal conventional equipment-endoscopic surgery feasible in patients with retrocecal acute appendicitis?  

PubMed Central

Purpose Since laparoscopic appendectomy was first described, various modifications, such as single port incisionless-intracorporeal conventional equipment-endoscopic surgery (SPICES), have been described for reducing pain and improving cosmetic results. In the retrocecal and retrocolic positions, attachments to the lateral peritoneum and cecum may lead to difficulties during SPICES, which is performed with only one port. Here, we present the effects of variations in the position of the vermiform appendix in treating acute appendicitis with SPICES. Methods We retrospectively reviewed 52 children who underwent SPICES for acute appendicitis between March 2010 and November 2011 in our institution. One group (group A) consisted of 30 patients (mean age, 10.5 ± 2.5 years) with retrocecal appendix, while the other group (group B) included 22 patients (mean age, 10.9 ± 2.3 years) with the appendix lying free in the peritoneal cavity. Results There were no significant differences between groups in terms of patient age, gender, success rate of SPICES, mean operating time, mean follow-up period, overall complication rates or mean postoperative hospitalization period. Conclusion These results suggest that SPICES is a safe and feasible approach even in patients with retrocecal acute appendicitis.

Karakus, Suleyman Cuneyt; Koku, Naim; Ertaskin, Idris

2013-01-01

226

Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum, and abdominal wall-lifting cholecystectomy  

Microsoft Academic Search

Background  Carbon dioxide (CO2) pneumoperitoneum effects are still controversial. The aim of this study was to investigate cardiopulmonary changes in patients\\u000a subjected to different surgical procedures for cholecystectomy.\\u000a \\u000a \\u000a \\u000a Methods  In this study, 15 patients were assigned randomly to three groups according to the surgical procedure to be used: open cholecystectomy\\u000a (OC), CO2 pneumoperitoneum cholecystectomy (PP), and laparoscopic gasless cholecystectomy (abdominal wall lifting

G. Galizia; G. Prizio; E. Lieto; P. Castellano; L. Pelosio; V. Imperatore; A. Ferrara; C. Pignatelli

2001-01-01

227

Laparoscopic Interventions in the Gut: Yesterday, Today, and Tomorrow  

Microsoft Academic Search

The development of laparoscopic interventional surgery has brought about a revolution in general surgery over the past 5 years. Laparoscopic cholecystectomy has now become the treatment of choice for symptomatic cholelithiasis because of a reduction in access trauma, resulting in less postoperative pain and a faster recovery. Laparoscopic fundoplication for gastroeosophageal reflux also looks to be a promising procedure which

Andrew J. McMahon; Patrick J. O’Dwyer; John N. Baxter

1996-01-01

228

Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial): study protocol for a randomized controlled trial  

PubMed Central

Background After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this waiting period, the patient is at risk of recurrent biliary events. In current clinical practice, surgeons usually postpone cholecystectomy for 6 weeks due to a perceived risk of a more difficult dissection in the early days following pancreatitis and for logistical reasons. We hypothesize that early laparoscopic cholecystectomy minimizes the risk of recurrent biliary pancreatitis or other complications of gallstone disease in patients with mild biliary pancreatitis without increasing the difficulty of dissection and the surgical complication rate compared with interval laparoscopic cholecystectomy. Methods/Design PONCHO is a randomized controlled, parallel-group, assessor-blinded, superiority multicenter trial. Patients are randomly allocated to undergo early laparoscopic cholecystectomy, within 72 hours after randomization, or interval laparoscopic cholecystectomy, 25 to 30 days after randomization. During a 30-month period, 266 patients will be enrolled from 18 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite endpoint of mortality and acute re-admissions for biliary events (that is, recurrent biliary pancreatitis, acute cholecystitis, symptomatic/obstructive choledocholithiasis requiring endoscopic retrograde cholangiopancreaticography including cholangitis (with/without endoscopic sphincterotomy), and uncomplicated biliary colics) occurring within 6 months following randomization. Secondary endpoints include the individual endpoints of the composite endpoint, surgical and other complications, technical difficulty of cholecystectomy and costs. Discussion The PONCHO trial is designed to show that early laparoscopic cholecystectomy (within 72 hours) reduces the combined endpoint of mortality and re-admissions for biliary events as compared with interval laparoscopic cholecystectomy (between 25 and 30 days) after recovery of a first episode of mild biliary pancreatitis. Trial registration Current Controlled Trials: ISRCTN72764151

2012-01-01

229

Fever and Diarrhea after Laparoscopic Bilioenteric Anastomosis  

PubMed Central

Bile duct injuries are well-known complications of laparoscopic and open cholecystectomies. Here, we report anastomosis of the common bile duct to the transverse colon that occurred as a complication of laparoscopic cholecystectomy. To the best of our knowledge, a similar case has not been reported in the literature so far. As in our patient, persistent diarrhea (in addition to fever and icterus) can be a warning sign of complication after these procedures. Surgeons who do advanced laparoscopic techniques must be familiar with this complication.

Fazeli, Mohammad S.; Kazemeini, Alireza; Safari, Saeed; Larti, Farnoosh

2011-01-01

230

Transanal single port surgery: selecting a suitable access port in a porcine model.  

PubMed

Single port surgery of rectal tumors may be associated with a shorter learning curve and fewer costs than transanal endoscopic microsurgery. The authors aimed to select the most optimal single access port for transanal employment. Four single access ports (GelPOINT, TriPort, SSL Access System, and SILS) were tested in 2 pigs. Insertion feasibility and intraoperative features of each port were assessed. A rectal excision was attempted using the most suitable port. Insertion of GelPOINT was impossible. SILS and TriPort were easily inserted; however, insufficient stability demanded manual fixation. CO2 leaked through the TriPort trocar ports. Insertion of the 2-cm SSL Access System retractor was difficult, but pneumorectum and surgical circumstances were favorable. Single port transanal surgery may be a promising alternative for transanal endoscopic microsurgery. The SSL Access System was found the most suitable for this indication in a porcine model. PMID:22064488

Barendse, Renée M; Verlaan, Tessa; Bemelman, Willem A; Fockens, Paul; Dekker, Evelien; Nonner, Joost; de Graaf, Eelco J R

2011-11-06

231

Health-related quality of life outcomes after cholecystectomy  

PubMed Central

Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.

Carraro, Amedeo; Mazloum, Dania El; Bihl, Florian

2011-01-01

232

Single-port Video-Assisted Thoracic Surgery for Lung Cancer  

PubMed Central

Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Because of its advantages, VATS is one of the surgical techniques widely used in patients with lung cancer. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single-port VATS for lung cancer has been attempted and its advantages have been reported. We describe our experiences of VATS for lung cancer with a single incision in this report.

Min, Ho Ki; Jun, Hee Jae; Hwang, Youn Ho; Kang, Min Kyun

2013-01-01

233

Open cholecystectomy. A contemporary analysis of 42,474 patients.  

PubMed Central

OBJECTIVE: This study evaluated, in a large, heterogeneous population, the outcome of open cholecystectomy as it is currently practiced. SUMMARY BACKGROUND AND DATA: Although cholecystectomy has been the gold standard of treatment for cholelithiasis for more than 100 years, it has recently been challenged by the introduction of several new modalities including laparoscopic cholecystectomy. Efforts to define the role of these alternative treatments have been hampered by the lack of contemporary data regarding open cholecystectomy. METHODS: A population-based study was performed examining all open cholecystectomies performed by surgeons in an eastern and western state during a recent 12-month period. Data compiled consisted of a computerized analysis of Uniformed Billing (UB-82) discharge analysis information from all non-Veterans Administration (VA), acute care hospitals in California (Office of Statewide Planning and Development [OSHPD]) and in Maryland (Health Services Cost Review Commission [HSCRC]) between January 1, 1989, and December 31, 1989. This data base was supplemented with a 5% random sample of Medicare UB-82 data from patients who were discharged between October 1, 1988, and September 30, 1989. Patients undergoing cholecystectomy were identified based on diagnosis-related groups (DRG-197 and DRG-198), and then classified by Principal Diagnosis and divided into three clinically homogeneous subgroups: acute cholecystitis, chronic cholecystitis, and complicated cholecystitis. RESULTS: A total of 42,474 patients were analyzed, which represents approximately 8% of all patients undergoing cholecystectomy in the United States in any recent 12-month period. The overall mortality rate was 0.17% and the incidence rate of bile duct injuries was approximately 0.2%. The mortality rate was 0.03% in patients younger than 65 years of age and 0.5% in those older than 65 years of age. Mortality rate, length of hospital stay, and charges were all significantly correlated (p < 0.001) with age, admission status (elective, urgent, or emergent), and disease status. CONCLUSIONS: These data indicate that open cholecystectomy currently is a very safe, effective treatment for cholelithiasis and is being performed with near zero mortality. The ultimate role of laparoscopic cholecystectomy needs to be defined in the context of current and contemporary data regarding open cholecystectomy.

Roslyn, J J; Binns, G S; Hughes, E F; Saunders-Kirkwood, K; Zinner, M J; Cates, J A

1993-01-01

234

Disturbances of Gastric Electrical Control Activity after Laparotomic Cholecystectomy Are Related to Interleukin6 Concentrations  

Microsoft Academic Search

Background: The aim of the present study was to characterize the disturbances of gastric electrical control activity after cholecystectomy and to correlate electrogastrographic (EGG) findings with inflammatory markers. Patients and Methods: 52 adult patients were examined in conjunction with planned laparotomic or laparoscopic cholecystectomy. Gastric myoelectrical activity was recorded with a MicroDigitrapper device using three Ag-AgCl disposable skin electrodes. The

P. Maruna; R. Frasko; J. Lindner

2009-01-01

235

Recent advances in laparoscopic surgery.  

PubMed

Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. PMID:23126424

Lee, Wei-Jei; Chan, Chien-Pin; Wang, Bing-Yen

2012-11-06

236

Retroperitoneal abscess from dropped appendicolith complicating laparoscopic appendectomy.  

PubMed

Abscesses can occur after appendectomy. With the increasing use of laparoscopy, this risk has increased in the same way as the incidence of abscesses related to dropped gallstones increased after laparoscopic cholecystectomy. However, this occurrence has been rarely reported. We describe here the case of a young patient who developed retroperitoneal abscess one year after laparoscopic appendectomy. PMID:17503311

Lambo, A; Nchimi, A; Khamis, J; Khuc, T

2007-04-01

237

Stress analysis of single port (ISB) jumper connectors for 2-, 3-, and 4-in. sizes  

SciTech Connect

Jumper connectors are used in the Hanford site for remotely connecting jumper pipe lines in the radioactive zones. The jumper pipes are used for transporting radioactive fluids and hazardous chemicals. This report evaluates the adequacy and the integrity of the 2-, 3-, and 4-in. single-port integral seal block (ISB) jumper connector assemblies, as well as the three-way 2-in. configuration. The evaluation considers limiting forces from the piping to the nozzle. A stress evaluation of the jumper components (hook, hook pin, operating screw, nozzle and nozzle flange, and block) under operational (pressure, thermal, dead weight, and axial torquing of the jumper) and seismic loading is addressed in the report.

Islam, M.A.; Julyk, J.L.; Weiner, E.O. [ICF Kaiser Hanford Co., Richland, WA (United States)

1995-05-26

238

Laparoscopic Surgery: A Pioneer's Point of View  

Microsoft Academic Search

.   For a surgeon who performed some of the first laparoscopic cholecystectomies, laparoscopic surgery is undoubtedly the main\\u000a revolution in the last decade of this century. It is impossible not to be fascinated by the extraordinary changes introduced\\u000a in our profession in less than 10 years. However, looking back in history, one realizes that laparoscopy is but one of those

Jacques Périssat; Bordeaux F

1999-01-01

239

A Study of Pain after Laparoscopic Gastric Banding  

Microsoft Academic Search

Background: The introduction of the laparoscopic approach to bariatric surgery has brought similar advantages as those seen\\u000a in general surgery.There have been no trials assessing postoperative pain after laparoscopic adjustable silicone gastric banding\\u000a (LASGB). We compared prospectively postoperative pain and outcome in LASGB and laparoscopic cholecystectomy (LC), to determine\\u000a if morbidly obese patients can expect the same benefits from a

H. Nehoda; M. Lanthaler; R. Mittermair; K. Hourmont; B. Labeck; H. Weiss; F. Aigner

2001-01-01

240

Design, simulation and evaluation of kinematic alternatives for Insertable Robotic Effectors Platforms in Single Port Access Surgery  

Microsoft Academic Search

This paper presents the task specifications for designing a novel Insertable Robotic Effectors Platform (IREP) with integrated stereo vision and surgical intervention tools for Single Port Access Surgery (SPAS). This design provides a compact deployable mechanical architecture that may be inserted through a single Ø15 mm access port. Dexterous surgical intervention and stereo vision are achieved via the use of

Jienan Ding; Kai Xu; Roger E. Goldman; Peter K. Allen; Dennis L. Fowler; Nabil Simaan

2010-01-01

241

Diversity gain from a single-port adaptive antenna using switched parasitic elements illustrated with a wire and monopole prototype  

Microsoft Academic Search

A new concept in single-port adaptive antennas using parasitic elements with switched terminating impedances is presented including results from a concept prototype. Each parasitic element can be effectively terminated in three impedance values. The antenna concept provides multiple radiation patterns with a single RF signal port without the need for RF switches or phase shifters in the direct RF signal

Neil L. Scott; Miles O. Leonard-Taylor; Rodney G. Vaughan

1999-01-01

242

Concomitant Laparoendoscopic Single-Site Surgery for Vesicolithotomy and Finger-Assisted Single-Port Transvesical Enucleation of the Prostate  

PubMed Central

Transurethral resection of the prostate is the most common surgery for benign prostatic hyperplasia. However, it doesn't work best for men with very large prostate and bladder stones. Herein we report our initial experience with concomitant laparoendoscopic single-site surgery and finger-assisted single-port transvesical enucleation of the prostate for the treatment of the condition.

Lee, Joo Yong; Kang, Dong Hyuk; Chung, Jae Hoon; Jo, Jung Ki

2011-01-01

243

Laparoscopic repair of parapubic hernia.  

PubMed

Since the introduction of laparoscopic cholecystectomy in the late 1980s, video technology has continued to find new applications in the field of general surgery. Laparoscopic inguinal herniorrhaphy is touted by many to provide a minimally invasive approach to the most commonly performed general surgical procedure, possibly with a lower incidence of recurrence. Additionally, laparoscopic repair of an incisional hernia with synthetic mesh allows a tension-free procedure while potentially reducing the risk of complications such as wound and mesh infections by avoiding the use of large abdominal wall incisions through old surgical scars. The parapubic hernia is a rare form of incisional hernia resulting from the detachment of muscular attachments to the pubic bone. It is a diagnostic and therapeutic challenge that is often misdiagnosed and mismanaged. We have found the laparoscopic approach to the parapubic hernia to be a superior method of managing this often challenging condition. PMID:11695979

Hirasa, T; Pickleman, J; Shayani, V

2001-11-01

244

Radiology of cholecystectomy complications.  

PubMed

Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed. PMID:761742

Love, L; Kucharski, P; Pickleman, J

1979-01-30

245

Urological applications of single-site laparoscopic surgery  

PubMed Central

Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings.

Symes, Andrew; Rane, Abhay

2011-01-01

246

Urological applications of single-site laparoscopic surgery.  

PubMed

Single-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Refinement and modification of laparoscopic instrumentation has resulted in a substantial increase in the use of laparoendoscopic single-site surgery (LESS) in urology over the past 2 years. Since the initial report of single-port nephrectomy in 2007, the majority of laparoscopic procedures in urology have been described with a single-site approach. This includes surgery on the adrenal, ureter, bladder, prostate, and testis, for both benign and malignant conditions. In this review, we describe the current clinical applications and results of LESS in Urological Surgery. To date this evidence comes from small case series in centres of excellence, with good results. Further well-designed prospective trials are awaited to validate these findings. PMID:21197251

Symes, Andrew; Rane, Abhay

2011-01-01

247

Intestinal ischemia following laparoscopic surgery: a case series  

PubMed Central

Introduction Intestinal ischemia is a rare complication of laparoscopic surgery. Its prognosis depends on a high index of suspicion and effective early treatment. Case presentation In the present report, we describe three cases where intestinal ischemia developed following laparoscopic surgery. Case 1 concerns a 52-year-old Caucasian man who developed large bowel ischemia following laparoscopic adjustable gastric band surgery. Case 2 concerns an 82-year-old Caucasian woman who developed fatal intestinal ischemia following laparoscopic cholecystectomy. Case 3 concerns a 58-year old Caucasian woman who developed right-sided lower intestinal ischemia following open cholecystectomy. Conclusions Intestinal ischemia is a rare complication of laparoscopic surgery. The identification of high-risk patients is an essential primary preventive measure. A high index of suspicion is required to make an early diagnosis, which may help improve outcomes.

2013-01-01

248

Laparoscopic use of laser and monopolar electrocautery  

NASA Astrophysics Data System (ADS)

Most general surgeons are familiar with monopolar electrocautery, but few are equally comfortable with laser dissection and coagulation. At courses across the country, surgeons are being introduced to laparoscopy and laser use in one and two day courses, and are certified from that day forward as laser laparoscopists. Some surgeons are told that laser and electrosurgery may be equally acceptable techniques for performance of laparoscopic surgery, but that a surgeon may double his patient volume by advertising 'laser laparoscopic cholecystectomy.' The sale of certain lasers has skyrocketed on the basis of such hype. The only surprise is that laparoscopic cholecystectomy complications occurring in this country seem to be more closely related to the laparoscopic access and visualization than to the choice of laser of electrocautery as the preferred instrument for thermal dissection. The purpose of this article is to: 1) Discuss the physics and tissue effects of electrosurgery and laser; 2) compare the design and safety of electrosurgical and laser delivery systems; and 3) present available data comparing laser and electrocautery application in laparoscopic cholecystectomy.

Hunter, John G.

1991-07-01

249

Anesthetic implications of laparoscopic surgery.  

PubMed Central

Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.

Cunningham, A. J.

1998-01-01

250

Feasibility and preliminary clinical outcomes of robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-port platform.  

PubMed

This study tested the technical feasibility and short-term perioperative outcomes of the novel da Vinci Single-Site Instrumentation platform for the treatment of upper ureteropelvic junction obstruction (UPJO) in a selected group of patients. Nine patients underwent robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-site platform for UPJO at our department of urology. All the procedures were completed without the need for traditional robotic surgery or laparoscopic/open conversion, although in one patient with congenital hepatomegaly it was necessary to use an auxiliary 3-mm trocar to retract the liver properly and expose the surgical field. Mean operative time was 166 min, and no intraoperative complications were recorded. The indwelling catheter was removed on postoperative day 2 in five patients and on postoperative day 3 in four patients. Patients were discharged the day after drain removal. One patient experienced transient hyperpyrexia, treated with antibiotics. No other complications were observed. All patients had the DJ stent removed 4 wk after surgery, following a negative urine culture and abdominal ultrasound evaluation. The five patients who reached a 3-mo follow-up had a clinical resolution of preoperative symptoms and hydronephrosis at the abdominal ultrasound. The same results were maintained in the two patients with 6-mo follow-up evaluations. In selected patients, R-LESS pyeloplasty using the new single-port platform appears to be a technically feasible and reproducible surgical procedure for the minimally invasive treatment of UPJO. Prolonged follow-up and larger series are required to confirm its potential role as a valid alternative to standard robotic pyeloplasty. PMID:22469392

Cestari, Andrea; Buffi, Nicolò Maria; Lista, Giuliana; Lughezzani, Giovanni; Larcher, Alessandro; Lazzeri, Massimo; Sangalli, Mattia; Rigatti, Patrizio; Guazzoni, Giorgio

2012-03-28

251

Clipless minilaparoscopic cholecystectomy: a study of 1096 cases.  

PubMed

Abstract Purpose: Low conversion rate, high safety, and good cosmetic result with less medical cost are chased by all laparoscopic surgeons. We used general laparoscopic instruments and combined with absorbable thread trying to perform a clipless minilaparoscopic cholecystectomy for benign gallbladder patients and got all the above-mentioned results. Subjects and Methods: From January 2008 to February 2011, 1096 minilaparoscopic cholecystectomies were performed for patients with uncomplicated or complicated benign gallbladder disease by our treatment team. The three-port technique with the help of an electrocautery hook, forceps, and suction was applied for laparoscopy cholecystectomy, and the cystic duct and vessels were ligated by absorbable thread rather than hemostasis clips and Harmonic(®) scalpels (Ethicon, Cincinnati, OH). The operative time, blood loss, subhepatic drain, conversion rate, drainage time, and hospital stay were reviewed and statistically analyzed. Results: Our conversion rate was 0.18%, which was much lower than those reported by many studies. The mean operating time was 28 minutes (range, 11-70 minutes). Mean blood loss was 12?mL (range, 5-200?mL). A subhepatic drain was placed in 63 patients, with a mean drainage time of 1.7 days (range, 1-6 days). The mean postoperative hospital stay was 2.5 days (range, 2-7 days). No postoperative bleeding, biliary leakage, intraabdominal infection, umbilical site infection, umbilical incision herniation, biliary duct or bowel injury, or mortality occurred. Conclusions: Minilaparoscopic cholecystectomy using absorbable thread instead of clips and Harmonic scalpels offers a safe, effective, and economical surgical alternative for benign gallbladder patients. PMID:23980592

Suo, Guangjun; Xu, Anan

2013-08-27

252

Laparoscopic managment of common bile duct stones: our initial experience.  

PubMed

The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence. PMID:12137159

Aroori, S; Bell, J C

2002-05-01

253

Outpatient laparoscopic surgery: feasibility and consequences for education and health care costs  

Microsoft Academic Search

Background The purpose of this paper is to describe the outcome of ambulatory laparoscopic cholecystectomy (LC), antireflux surgery, adrenalectomy and splenectomy and possible implications for surgical education and health care costs. Methods Prospective, observational study 1994–2003. Results The success rate of ambulatory treatment was 83.5% in 1060 LC patients, 80% in 113 antireflux procedures, 100% in 22 laparoscopic adrenalectomies, and

J. Skattum; B. Edwin; E. Trondsen; O. Mjåland; J. Raeder; T. Buanes

2004-01-01

254

Laparoscopic surgery for common surgical emergencies: A population-based study  

Microsoft Academic Search

Background: Despite being controversial in the past, many reports on the safe use of laparoscopic surgery in emergency settings have been published. The aim of this study was to investigate the diffusion of laparoscopic surgery in three common surgical emergency operations, namely, appendectomy, cholecystectomy, and simple repair of perforated peptic ulcer (PPU), in a stable population. Methods: This was a

C. M. Lam; A. W. Yuen; B. Chik; A. C. Wai; S. T. Fan

2005-01-01

255

Evaluation of a novel single-port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology  

Microsoft Academic Search

ObjectivesThe purpose of this protocol was to evaluate the feasibility and reproducibility of a dedicated da Vinci® single-port robotic platform in cadavers for the performance of various gynecologic oncology procedures.

Pedro F. Escobar; Mehdi Kebria; Tommaso Falcone

2011-01-01

256

Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience  

PubMed Central

Background During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes. Methods 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed. Results At discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications. Conclusions The broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.

2013-01-01

257

Transumbilical single-incision laparoscopic hepatectomy: an initial report.  

PubMed

Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery. PMID:21518578

Hu, Ming-Gen; Zhao, Guo-Dong; Xu, Da-Bing; Liu, Rong

2011-03-01

258

Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results  

Microsoft Academic Search

Background  The influence of experience on the results of treatment with laparoscopic surgery is indisputable. The establishment of indications\\u000a and contraindications is relative, and varies depending on the experience of the surgeon. Learning curves have been described\\u000a for a number of laparoscopic interventions, in particular laparoscopic cholecystectomy. The current prospective multicenter\\u000a study investigates, among other things, the interrelation between experience and

F. Marusch; I. Gastinger; C. Schneider; H. Scheidbach; J. Konradt; H. P. Bruch; L. Köhler; E. Bärlehner; F. Köckerling

2001-01-01

259

An audit of laparoscopic surgeries in ile-ife, Nigeria.  

PubMed

Background: After several years of lagging behind due to several constraints, many general surgeons across Nigeria are now performing laparoscopic surgery. An audit of the procedure in our setting is required. Objective: To describe the outcome of consecutive laparoscopic general surgical procedures performed at the Obafemi Awolowo University Teaching Hospital, South-western Nigeria. Methods: All patients with general surgical conditions who had laparoscopic surgery from January 2009 through May 2010 in our hospital were prospectively studied and type of pre, intra and postoperative data including sex, age, indication for surgery, and outcome of the procedure were obtained and analysed. Results: Sixty-two patients (ages 18 to 72 years) had laparoscopic surgeries within the study period. Eighteen (29%) patients had laparoscopic cholecystectomy, 13 (21%) had laparoscopic appendicectomy, 10 (16.1%) had laparoscopic adhesiolysis, 7 (11.3%) laparoscopic biopsies of intraabdominal masses while 14(22.6%) others had diagnostic laparoscopies for a range of suspected abdominal conditions. All diagnostic procedures were performed as day cases while the duration of hospital stay was one to two days for the therapeutic procedures. Two(3%) procedures, including a biopsy of hepatic mass and a cholecystectomy were converted to open surgery due to significant haemorrhage. A minor bile duct injury was recorded in one patient who had cholecystectomy and superficial port site wound infections were noticed in two patients who had appendectomy. No mortality was recorded. Conclusion: Our results show the feasibility of laparoscopic surgery in Nigeria. We advocate local adaptation and improvisations to increase the use of laparoscopic surgery in Nigerian hospitals. PMID:22669832

Adisa, A O; Lawal, O O; Alatise, O I; Adesunkanmi, A R

260

Getting started with robotics in general surgery with cholecystectomy: the Canadian experience  

PubMed Central

Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures.

Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

2009-01-01

261

Prophylactic cholecystectomy during abdominal surgery.  

PubMed

The presence of asymptomatic gallstones is no longer an indication for elective prophylactic cholecystectomy (PC) according to the recommendations of the 1991 French Consensus Conference on cholelithiasis. However, there may be potential benefits of performing prophylactic cholecystectomy during certain abdominal procedures for non-biliary disease; this remains a subject of debate. This debate has become livelier with the recent increase in bariatric surgery. Gastrectomy for cancer, small bowel resection, colonic resection, and splenectomy for hereditary spherocytosis as well as all bariatric surgical interventions can all alter the physiology of gallstone disease raising the question of the value of PC, but the specific morbidity of cholecystectomy must be kept in mind. The purpose of this study was to report epidemiological and pathophysiological data and the results from literature reports in order to assess the value of concomitant prophylactic cholecystectomy during various common surgical situations. PMID:23916848

Cabarrou, P; Portier, G; Chalret Du Rieu, M

2013-08-02

262

Outcomes of Xanthogranulomatous cholecystitis in laparoscopic era: A retrospective Cohort study  

PubMed Central

INTRODUCTION: Xanthogranulomatous cholecystitis (XGC) is a rare variant of cholecystitis and reported incidence of XGC varies from different geographic region from 0.7% -9%. Most of the clinicians are not aware of the pathology and less evidence is available regarding the optimal treatment of this less common form of cholecystitis in the present era of laparoscopic surgery. MATERIALS AND METHODS: A retrospective cohort study was conducted in a tertiary care university hospital from 1989 to 2009. Histopathologically confirmed XGC study patients (N=27) were compared with non-Xanthogranulomatous cholecystitis (NXGC) control group (N=27). The outcomes variables were operative time, complication rate and laparoscopic to open cholecystectomy conversion rate. The study group (XGC) was further divided in to three sub groups; group I open cholecystectomy (OC), laparoscopic cholecystectomy (LC) and laparoscopic converted to open cholecystectomy (LCO) for comparative analysis to identify the significant variables. RESULTS: During the study period 6878 underwent cholecystectomy including open cholecystectomy in 2309 and laparoscopic cholecystectomy in 4569 patients. Histopathology confirmed xanthogranulomatous cholecystitis in 30 patients (0.43% of all cholecystectomies) and 27 patients qualified for the inclusion criterion. Gallbladder carcinoma was reported in 100 patients (1.45%) during the study period and no association was found with XGC. The mean age of patients with XGC was 49.8 year (range: 29-79), with male to female ratio of 1:3. The most common clinical features were abdominal pain and tenderness in right hypochondrium. Biliary colic and acute cholecystitis were the most common preoperative diagnosis. Ultrasonogram was performed in all patients and CT scan abdomen in 5 patients. In study population (XGC), 10 were patients in group I, 8 in group II and 9 in group III. Conversion rate from laparoscopy to open was 53 % (n=9), surgical site infection rate of 14.8% (n=4) and common bile duct injury occurred one patient in open cholecystectomy group (3.7%). Statistically significant differences between group I and group II were raised total leukocyte count: 10.6±3.05 vs. 7.05±1.8 (P-Value 0.02) and duration of surgery in minutes: 248.75±165 vs. 109±39.7 (P-Value 0.04). The differences between group III and group II were duration of surgery in minutes: 208.75±58 vs. 109±39.7 (P-Value 0.03) and duration of symptoms in days: 3±1.8 vs. 9.8±8.8 (P-Value 0.04). The mean hospital stay in group I was 9.7 days, group II 5.6 days and in group III 10.5 days. Two patients underwent extended cholecystectomy based on clinical suspicion of carcinoma. No mortality was observed in this study population. Duration of surgery was higher in XGC group as compared to controls (NXGC) (203±129 vs.128±4, p-value=0.008) and no statistically significant difference in incidence proportion of operative complication rate were observed among the group (25.9% vs. 14.8%, p-value=0.25. Laparoscopic surgery was introduced in 1994 and 17 patients underwent laparoscopic cholecystectomy and higher conversion rate from laparoscopic to open cholecystectomy was observed in 17 study group (XGC) as compared to 27 Control group (NXGC) 53%vs.3.3% with P-value of < 0.023. CONCLUSION: XGC is a rare entity of cholecystitis and preoperative diagnosis is a challenging task. Difficult dissection was encountered in open as well in laparoscopic cholecystectomy with increased operation time. Laparoscopic cholecystectomy was carried out with high conversion rate to improve the safety of procedure. Per operative clinical suspicion of malignancy was high but no association of XGC was found with gallbladder carcinoma, therefore frozen section is recommended before embarking on radical surgery.

Alvi, Abdul Rehman; Jalbani, Imran; Murtaza, Ghulam; Hameed, Aamir

2013-01-01

263

Surgical Techniques of Laparoscopic Inguinal Hernia Repair in Childhood: A Critical Appraisal  

PubMed Central

Laparoscopic inguinal hernia repair started over two decades ago. It has been gaining ground as a mode of treatment for inguinal hernia in children. Several surgical techniques have emerged since its inception. The aim of this article is to review the role of laparoscopy in inguinal hernia repair in children, the various emerging laparoscopic surgical techniques, and their current trend in pediatric surgical practice. In this study, extensive review and analysis of recent articles on laparoscopic inguinal hernia repair in children revealed that laparoscopy plays a great role in the treatment of inguinal hernia in children. There were several emerging laparoscopic techniques, with trends toward extracorporeal suturing and knotting technique and single-port access technique as well. The recent advance is toward the use of tissue adhesives in laparoscopic inguinal hernia repair in children.

Lukong, Christopher S.

2012-01-01

264

Surgical techniques of laparoscopic inguinal hernia repair in childhood: a critical appraisal.  

PubMed

Laparoscopic inguinal hernia repair started over two decades ago. It has been gaining ground as a mode of treatment for inguinal hernia in children. Several surgical techniques have emerged since its inception. The aim of this article is to review the role of laparoscopy in inguinal hernia repair in children, the various emerging laparoscopic surgical techniques, and their current trend in pediatric surgical practice. In this study, extensive review and analysis of recent articles on laparoscopic inguinal hernia repair in children revealed that laparoscopy plays a great role in the treatment of inguinal hernia in children. There were several emerging laparoscopic techniques, with trends toward extracorporeal suturing and knotting technique and single-port access technique as well. The recent advance is toward the use of tissue adhesives in laparoscopic inguinal hernia repair in children. PMID:23066453

Lukong, Christopher S

2012-01-01

265

Laparoscopic sleeve gastrectomy in management of weight regain after failed laparoscopic plication?  

PubMed Central

INTRODUCTION Weight regain after bariatric surgery remains a challenging problem with regard to its surgical management. PRESENTATION OF CASE A 30 year-old-female patient with weight regain after failed laparoscopic gastric plication and previous gastric banding was evaluated in a tertiary-care university setting. Her last body mass index was calculated as 40.4 kg/m2. Preoperative ultrasonography revealed cholelithiasis. Laparoscopic sleeve gastrectomy with cholecystectomy was planned as a redo surgery. A floopy and plicated stomach with increased wall thickness of the greater curvature was seen. After adhesiolysis between the plicated part of stomach and the surrounding omental tissues, concomitant laparoscopic sleeve gastrectomy and cholecystectomy were performed. She was discharged on the 4th post-operative day without any complaint. At the postoperative 3rd month, her body mass index was recorded as 24 kg/m2. DISCUSSION Redo surgery of morbid obesity after failed bariatric surgery is a technically demanding issue. Type of the surgical treatment should be decided by the attending surgeon based on the morphology of the remnant stomach caused by previous operations. CONCLUSION As a redo surgery after failed laparoscopic gastric plication and gastric banding procedures, laparoscopic sleeve gastrectomy may be regarded as a safe and feasible approach in experienced hands.

Coskun, Halil; Cipe, Gokhan; Bozkurt, Suleyman; Bektasoglu, Huseyin Kazim; Hasbahceci, Mustafa; Muslumanoglu, Mahmut

2013-01-01

266

Transthoracic single port with peroral assistance: an animal experiment to assess a less invasive technique for human esophageal atresia repair.  

PubMed

Thoracoscopic repair of esophageal atresia has becoming the gold standard in many centers because it allows a better cosmetic result and avoids the musculoskeletal sequelae of a thoracotomy. Natural orifice translumenal endocopic surgery (NOTES) is a new surgical paradigm, and its human application has already been started in some procedures. In the present study, we explore the feasibility of performing an esophagoesophageal anastomosis using a single transthoracic single port combined with a peroral access in a rabbit model to simulate repair of esophageal atresia by hybrid NOTES in a human newborn. Adult male rabbits (Oryctolagus cuniculus, n=28) were used to perform the surgical protocol. We used a transthoracic telescope with a 3-mm working channel and a flexible endoscope with a 2.2-mm working channel by peroral access. We performed total esophagotomy with peroral scissors followed by an esophagoesophageal anastomosis achieved with a rigid transthoracic scope helped by the peroral operator. Extracorporeal transthoracic knots were performed to complete the anastomosis. The anastomoses were examined in loco and ex loco, after animal sacrifice. We successfully accomplished a complete esophageal anastomosis in all rabbits using a combination of transthoracic and peroral 3-mm instruments. This study provides important insights for a possible translation of hybrid NOTES to human newborns with esophageal atresia. Forward studies to accomplish their feasibility in human newborns will still be necessary. PMID:23190042

Henriques-Coelho, Tiago; Soares, Tony R; Miranda, Alice; Moreira-Pinto, João; Correia-Pinto, Jorge

2012-11-28

267

Umbilical incision laparoscopic surgery with one assist port for an elderly patient with recurrent sigmoid volvulus.  

PubMed

Single-port access laparoscopic surgery has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. Herein, we report the experience of transumbilical incision laparoscopic sigmoidectomy with one assist port in a 71-year-old man who had developed recurrent sigmoid volvulus in these several years since his first visit to the hospital. The patient presented abdominal distension and severe constipation. A plain x-ray film and CT of the abdomen showed grossly distended sigmoid colon loops and stenosis of recto-sigmoid colon. Sigmoid volvulus associated with megacolon was diagnosed and emergence endoscopic decompression was performed. After his condition improved, transumbilical incision laparoscopic sigmoidectomy was carried out as the minimally invasive approach, due to the several risk of patient such as aging and pulmonary disorder. Postoperative course was uneventful and on postoperative visit to the hospital he reported resolution of abdominal distension. PMID:23235104

Matsuoka, Tasuku; Osawa, Naoshi; Yoh, Taiho; Hirakawa, Kosei

2012-12-12

268

Insufficient cholecystectomy diagnosed by endoscopic ultrasonography.  

PubMed

Recurrent attacks of upper right quadrant pain after cholecystectomy are not infrequent. In most of these cases, the cause of the pain remains undiagnosed. Insufficient cholecystectomy has been described as a rare cause of post-cholecystectomy pain, although the true incidence is unknown. It is difficult to diagnose a residual gallbladder or a large cystic duct with residual stones, due to the size of the remaining structures. This report presents three patients who had experienced a long period of agonizing biliary-type pain after cholecystectomy. Abdominal ultrasound examinations, and magnetic resonance cholangiopancreatography (MRCP) in one patient, were normal. Endoscopic ultrasonography (EUS) demonstrated the presence of a small cystic structure with echogenic foci compatible with a residual gallbladder containing small gallstones. Two of the three diagnoses were confirmed by repeat surgery. EUS thus appears to be a valuable method for diagnosing insufficient cholecystectomy, and should be considered in patients with persistent pain attacks after cholecystectomy. PMID:14986224

Hassan, H; Vilmann, P

2004-03-01

269

The improving results of cholecystectomy.  

PubMed

We reviewed the outcome of 389 consecutive patients undergoing cholecystectomy during the ten-year period from 1973 to 1983. Significant discrepancies between this series and other published data were noted as follows: Patients with acute cholecystitis, although older, had comparable morbidity and mortality rates with patients undergoing elective cholecystectomy. Diabetic and nondiabetic patients with acute cholecystitis had similar outcomes. In those patients with acute cholecystitis, delay in operation after hospital admission did not increase operative technical difficulties, morbidity, or length of postoperative hospitalization, although total hospitalization was prolonged. The histologic reports of gallbladder pathology in those patients with a clinical diagnosis of acute cholecystitis did not disclose acute inflammatory changes in 39% of cases, raising questions about the validity of previous reviews of patients with acute cholecystitis in which the microscopic diagnosis alone was used. PMID:3729712

Pickleman, J; González, R P

1986-08-01

270

Cholelithiasis, Cholecystectomy, and Liver Disease  

Microsoft Academic Search

OBJECTIVES:Cholelithiasis and fatty liver disease share some important risk factors, such as central obesity, insulin resistance, and diabetes. We sought to determine whether persons with cholelithiasis or a history of cholecystectomy were more likely to have elevated serum liver enzymes or to develop cirrhosis.METHODS:We used cohort data from the first National Health and Nutrition Examination Survey (NHANES), to determine whether

George N Ioannou

2010-01-01

271

Isolated right posterior bile duct injury following cholecystectomy: Report of two cases  

PubMed Central

Anatomic variations of the right biliary system are one of the most common risk factors for sectoral bile duct injury (BDI) during cholecystectomy. Isolated right posterior BDI may in particular be a challenge for both diagnosis and management. Herein we describe two cases of isolated right posterior sectoral BDI that took place during laparoscopic cholecystectomy. Despite effective external biliary drainage from the liver hilum in both cases, there was a persistent biliary leak observed which was not visible on endoscopic retrograde cholangiogram. Careful evaluation of images from both endoscopic and magnetic resonance cholangiograms revealed the diagnosis of an isolated right posterior sectoral BDI. These were treated with a delayed bisegmental (segments 6 and 7) liver resection and a Roux-en-Y hepaticojejunostomy respectively with good outcomes at 24 and 4 mo of follow-up. This paper discusses strategies for prevention of such injuries along with the diagnostic and therapeutic challenges it offers.

Wojcicki, Maciej; Patkowski, Waldemar; Chmurowicz, Tomasz; Bialek, Andrzej; Wiechowska-Kozlowska, Anna; Stankiewicz, Rafal; Milkiewicz, Piotr; Krawczyk, Marek

2013-01-01

272

Current Limitations and Perspectives in Single Port Surgery: Pros and Cons Laparo-Endoscopic Single-Site Surgery (LESS) for Renal Surgery  

PubMed Central

Laparo-Endoscopic Single-Site surgery (LESS) for kidney diseases is quickly evolving and has a tendency to expand the urological armory of surgical techniques. However, we should not be overwhelmed by the surgical skills only and weight it against the basic clinical and oncological principles when compared to standard laparoscopy. The initial goal is to define the ideal candidates and ideal centers for LESS in the future. Modification of basic instruments in laparoscopy presumably cannot result in better functional and oncological outcomes, especially when the optimal working space is limited with the same arm movements. Single port surgery is considered minimally invasive laparoscopy; on the other hand, when using additional ports, it is no more single port, but hybrid traditional laparoscopy. Whether LESS is a superior or equally technique compared to traditional laparoscopy has to be proven by future prospective randomized trials.

Weibl, Peter; Klingler, Hans-Christoph; Klatte, Tobias; Remzi, Mesut

2010-01-01

273

A modified single-port technique for the minimally invasive treatment of pediatric inguinal hernias with high ligation of the vaginal process: the initial experience  

Microsoft Academic Search

The aim of this study is to evaluate a modified single-port technique for treating pediatric inguinal hernias (PIH) with high\\u000a ligation of the vaginal process by combining the use of a ureteroscope and a custom-made puncture guide under pneumoperitoneum.\\u000a The cases of 86 patients with PIH who underwent the procedure in our institution were reviewed. All of the operations were

Wenhao Shen; Huixiang Ji; Gensheng Lu; Zhiwen Chen; Longkun Li; Heng Zhang; Jinhong Pan

2010-01-01

274

Pulmonary Embolism Following Laparoscopic Antireflux Surgery: A Case Report and Review of the Literature  

PubMed Central

Deep venous thrombosis and pulmonary embolism are concerning causes of morbidity and mortality in patients undergoing general surgical procedures. Laparoscopic surgery has gained rapid acceptance in the past several years and is now a commonly performed procedure by most general surgeons. Multiple anecdotal reports of pulmonary embolism following laparoscopic cholecystectomy have been reported, but the true incidence of deep venous thrombosis and pulmonary embolism in patients undergoing laparoscopic surgery is not known. We present a case of pulmonary embolism following laparoscopic repair of paraesophageal hernia. The literature is then reviewed regarding the incidence of pulmonary embolism following laparoscopic surgery, the mechanism of deep venous thrombosis formation, and the recommendations for deep venous thrombosis prophylaxis in patients undergoing laparoscopic procedures.

Luketich, James D.; Friedman, David M.; Ikramuddin, Sayeed; Schauer, Phil R.

1999-01-01

275

Coelioscopic cholecystectomy. Preliminary report of 36 cases.  

PubMed Central

Intra-abdominal endoscopy, routinely used for gynecologic operations can be extended safely for cholecystectomy in uncomplicated cholelithiasis. Thirty-six patients underwent coelioscopic cholecystectomy with few and only benign complications. The main advantages are cosmetic preservation, reduction of postoperative pain, shortening of hospital stay, and early recovery of a normal activity. Images Fig. 2.

Dubois, F; Icard, P; Berthelot, G; Levard, H

1990-01-01

276

Retrograde (fundus first) Laparoscopic Cholecystectomy in Situs Inversus Totalis  

PubMed Central

Situs inversus totalis (SIT) is an uncommon anomaly characterised by transposition of organs to the opposite side of the body in a mirror image of normal. It may cause difficulties in the diagnostic and therapeutic management of abdominal pathology due to the mirror-image anatomy. We report the management of a case of symptomatic cholilithiasis with emphasis on its surgical technique.

Elbeshry, Turky Maeed; Ghnnam, Wagih Mommtaz

2012-01-01

277

A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis  

Microsoft Academic Search

BackgroundFew articles address the issue of LC in patients with cirrhosis. Existing articles are retrospective and with small sample sizes, which makes it difficult to draw conclusions about indications and complications with LC in this setting.

Alessandra Puggioni; Linda L Wong

2003-01-01

278

Knowledge and opinions regarding Medicare reimbursement for laparoscopic cholecystectomy  

Microsoft Academic Search

Background  Medicare, via its fee schedule, determines amount of payment to physicians for services for its beneficiaries. Because many\\u000a private insurance companies base their payment schedule on Medicare rates, it is important for physicians to know the rates\\u000a of commonly performed procedures. In addition, it seems that public perception is that physicians receive substantial payments\\u000a for procedures. This investigation explores patient,

Atul K. Madan; David S. Tichansky; Ginny E. Barton; Raymond J. Taddeucci

2007-01-01

279

Is it necessary to retrieve dropped gallstones during laparoscopic cholecystectomy?  

Microsoft Academic Search

.  \\u000a \\u000a Background: An experimental study was planned to evaluate the effect of bile alone and bile in combination with gallstones on intraperitoneal\\u000a adhesion and abscess formation in the peritoneal cavity of the rat.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: One hundred Sprague-Dawley rats were assigned to ten groups (n: 10). Groups 1–3 received a 1-ml intraperitoneal injection of saline, sterile bile, and infected bile. Groups

A. Zorluo?lu; H. Özgüç; T. Yilmazlar; N. Güney

1997-01-01

280

A rare complication of laparoscopic surgery  

PubMed Central

Gallstone disease is one of the most common problems affecting the digestive tract. Symptomatic patients are advised to undergo laparoscopic cholecystectomy (LC), which is considered the gold standard of care in these patients. LC has clear advantages over traditional surgery such as a shorter hospital stay, an earlier return to work and better patient satisfaction. Despite LC being a common surgical procedure, it is not totally free from complications. These include cardiorespiratory problems, biliary leakage, peritonitis, hemorrhage and superior mesenteric artery (SMA) occlusion. We report an unusual and fatal complication of LC, being SMA thrombosis complicated by multiple intra-abdominal collections, abdominal compartment syndrome, multiorgan failure and septic shock.

Shaikh, Nissar; Rahman, Husham Abdul; Hanssens, Yolande; John, Sunil

2011-01-01

281

Late choledochal pathology after cholecystectomy for cholelithiasis.  

PubMed

After "simple" cholecystectomy for lithiasis, biliary disorders can appear, with the onset more than 3 years postoperative, like cholangitis or transitory jaundice. Meantime, a whole range of congenital abnormalities initially ignored can become manifest: biliary tract congenital dilatations, duodenal para-Vater diverticulum, Oddi stenosis. Aim: to establish the pathological circumstances that determine late choledochal syndrome, including an analysis concerning the therapeutical approach in these cases. Patients with cholecystectomy complains of late biliary disorders (least 3 years symptom-free) between 1997-2005, were retrospectively studied. Exclusion criteria were intraoperative incidents or accidents, recognised incomplete surgical procedure, early difficult postoperative course. Therapeutical approach was endoscopical, surgical or conservative. 46 patients entered the study group; 38 underwent open cholecystectomy. Mean interval between operation and disturbances onset was 10 years. Following etiopathologic causes of late choledochal pathology were recorded: incomplete cholecystectomy, retained or primary common bile duct (CBD) stones, choledochal cyst or stenosis, Oddi stenosis, duodenal para-Vater diverticulum, anomaly biliary tree. Thirty patients undergone successful endoscopic treatment; in 8 cases endoscopy failed, in 2 cases open surgery was the first choice; 5 diagnostic endoscopic cholangiography with conservative treatment were performed; 1 patient refused any procedure. Cholecystectomy indication is regularly based on clinical and ultrasound examination criteria. Even a simple cholecystectomy can be followed after first 3 years by cholangitis, obstructive jaundice, caused by initially ignored biliary tract pathology. To avoid such omissions, routine intraoperative cholangiography and duodenal endoscopy should precede cholecystectomy. On the other side, cholecystectomy itself can cause late complaints: retained CBD stones, gallbladder stump, and iatrogenic stenosis. The duodenal para-Vater diverticulum seems to have a more important role in biliary disturbances, before and after cholecystectomy. PMID:16927918

Br?tucu, E; Straja, D; Marinca?, M; Daha, C; Cirimbei, C; Boru, C

282

Kurt Semm and the Fight against Skepticism: Endoscopic Hemostasis, Laparoscopic Appendectomy, and Semm's Impact on the "Laparoscopic Revolution"  

PubMed Central

In the 1970s, Semm developed thermocoagulation, adapted the Roeder Loop, and further invented extra- and intracorporeal endoscopic knotting to achieve endoscopic hemostasis. His numerous technical inventions, especially the electronic insufflator, allowed more complex operations to be performed laparoscopically. His technique, however, was not quickly adopted by the surgical community. When the first fully laparoscopic appendectomy was carried out by Semm in 1980, a veritable storm broke loose. In the opinion of many prominent surgeons, Semm exaggerated the problem of adhesions, and laparoscopic technique itself was regarded as very dangerous. Misunderstood by medical scientists, Semm displayed an ability to force his ideas through despite skepticism and suspicion. He realized that endoscopic surgery had tremendous potential, and promoted laparoscopic technique not only in his field of gynecology but among general surgeons as well. In 1985, Muhe, of Boblingen, Germany, used Semm's technique to remove the first gallbladder in the world laparoscopically. Three years later when Semm presented a videotape of his laparoscopic appendectomy in Baltimore, he gave impetus to McKernan and Saye of Marietta, Georgia, to carry out the first laparoscopic cholecystectomy in the United States.

1998-01-01

283

'Extreme' vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders  

PubMed Central

Objectives Extreme vasculobiliary injuries usually involve major hepatic arteries and portal veins. They are rare, but have severe consequences, including rapid infarction of the liver. The pathogenesis of these injuries is not well understood. The purpose of this study was to elucidate the mechanism of injury through an analysis of clinical records, particularly the operative notes of the index procedure. Methods Biliary injury databases in two institutions were searched for data on extreme vasculobiliary injuries. Operative notes for the index procedure (cholecystectomy) were requested from the primary institutions. These notes and the treatment records of the tertiary centres to which the patients had been referred were examined. Radiographs from the primary institutions, when available, as well as those from the tertiary centres, were studied. Results Eight patients with extreme vasculobiliary injuries were found. Most had the following features in common. The operation had been started laparoscopically and converted to an open procedure because of severe chronic or acute inflammation. Fundus-down cholecystectomy had been attempted. Severe bleeding had been encountered as a result of injury to a major portal vein and hepatic artery. Four patients have required right hepatectomy and one had required an orthotopic liver transplant. Four of the eight patients have died and one remains under treatment. Conclusions Extreme vasculobiliary injuries tend to occur when fundus-down cholecystectomy is performed in the presence of severe inflammation. Contractive inflammation thickens and shortens the cystic plate, making separation of the gallbladder from the liver hazardous.

Strasberg, Steven M; Gouma, Dirk J

2012-01-01

284

Shoulder Tip Pain After Laparoscopic Surgery Analgesia by Collateral Meridian Acupressure (Shiatsu) Therapy: A Report of 2 Cases  

Microsoft Academic Search

ObjectivesThis article describes 2 cases of collateral meridian acupressure (shiatsu) therapy (CMAT) for treatment of shoulder tip pain after laparoscopic cholecystectomy (LC). Both cases showed marked pain relief with reduction of skin temperature (1°C) of the affected shoulder after CMAT.

Chun-Chang Yeh; Shan-Chi Ko; Billy K. Huh; Chang-Po Kuo; Ching-Tang Wu; Chen-Hwan Cherng; Chih-Shung Wong

2008-01-01

285

Laparoscopic splenectomy: a selected retrospective review.  

PubMed

Previous investigators have suggested that laparoscopic splenectomy should be the procedure of choice for the treatment of benign hematologic disorders unresponsive to medical therapy. To evaluate the safety and utility of laparoscopic splenectomy for a variety of splenic disorders, we reviewed our collective experience at 2 institutions. We studied our 8-year experience by retrospective chart review. Patient demographic data, splenic pathology, intraoperative events, concomitant procedures, and all adverse perioperative events were recorded. A total of 131 patients had laparoscopic splenectomy, and there were 8 conversions to open surgery. Pathology included 63 with idiopathic thrombocytopenic purpura (ITP), 23 malignancies, 12 thrombotic thrombocytopenic purpura (TTP), 10 autoimmune hemolytic anemia (AIHA), and 23 others. Accessory spleens were noted in 21 patients (16%). Concomitant surgical procedures included 12 hepatic biopsies, 4 distal pancreatectomies, 4 cholecystectomies, and 7 others. Mean operative time was 170 minutes. There were 16 major complications in 16 patients and 2 deaths. Median postoperative length of stay was 3 days. Conversions, due mostly to bleeding, are related to splenic pathology and medical comorbidity and are not temporally related to surgical experience (learning curve). The morbidity, mortality, and conversion rates were low. Laparoscopic splenectomy permits an appropriate abdominal exploration and is associated with a short hospital stay. It is the procedure of choice for most indications for splenectomy. PMID:15956897

Pomp, Alfons; Gagner, Michel; Salky, Barry; Caraccio, Alfio; Nahouraii, Richard; Reiner, Mark; Herron, Daniel

2005-06-01

286

Laparoscopic Management of Gallstone Ileus  

PubMed Central

Gallstone ileus is an uncommon entity that was first described by Bartholin in 1654. Despite advances in peri-operative care, morbidity and mortality remain high in patients with gallstone ileus because: 1) they are geriatric patients; 2) they often have multiple comorbidities; 3) presentation to the hospital is delayed; 4) many are volume depleted with electrolyte abnormalities; and 5) the diagnosis of gallstone ileus is difficult to make. Traditional management has entailed open laparotomy with relief of intestinal obstruction by enterotomy and stone extraction. Cholecystectomy and takedown of the cholecystoenteric fistula can be performed. We propose an alternative method of management in an attempt to limit operative trauma and improve morbidity and mortality. We review the literature and describe two patients with gallstone ileus who were managed laparoscopically. One patient underwent laparoscopic assisted enterolithotomy, and the other patient underwent diagnostic laparoscopy with disimpaction of the gallstone into the large bowel. They were discharged after their ileus had resolved on the fourth and sixth postoperative day, respectively. Laparoscopy is a powerful diagnostic and therapeutic tool that can be effectively used to treat gallstone ileus.

Evan, Stephen J.; Kavic, Michael S.

2001-01-01

287

A modified single-port technique for the minimally invasive treatment of pediatric inguinal hernias with high ligation of the vaginal process: the initial experience.  

PubMed

The aim of this study is to evaluate a modified single-port technique for treating pediatric inguinal hernias (PIH) with high ligation of the vaginal process by combining the use of a ureteroscope and a custom-made puncture guide under pneumoperitoneum. The cases of 86 patients with PIH who underwent the procedure in our institution were reviewed. All of the operations were completed uneventfully. The median operative times for unilateral and bilateral lesions were 11 min (range, 8-15 min) and 16 min (range, 12-20 min), respectively. All of the patients were discharged from the hospital on the day of surgery. No massive hemorrhages or infections were reported. The median follow-up was 15 months (range, 12-24 months), during which no recurrences were reported. In conclusion, with the aid of a ureteroscope and a modified custom-made puncture suit, the described single-port technique allowed easier induction of the ligation suture and a shorter operative time than other methods reported previously. However, the determination of long-term efficacy requires additional studies with larger sample sizes and longer follow-up times. PMID:20424857

Shen, Wenhao; Ji, Huixiang; Lu, Gensheng; Chen, Zhiwen; Li, Longkun; Zhang, Heng; Pan, Jinhong

2010-04-28

288

Minilaparoscopic (needlescopic) cholecystectomy: a study of 1,011 cases  

Microsoft Academic Search

Background: The safety and feasibility of minilaparoscopic cholecystectomy has not been documented with a large patient sample. This study reports the results of 1,011 minilaparoscopic cholecystectomies performed in a single institution. Methods: From November 1997 to May 2002, 1,023 consecutive patients underwent minilaparoscopic cholecystectomy at National Taiwan University Hospital, Taipei, Taiwan. Patients with clinical evidence of common bile duct stones

P.-C. Lee; I.-R. Lai; S.-C. Yu

2004-01-01

289

Technical and Technological Skills Assessment in Laparoscopic Surgery  

PubMed Central

Objectives: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation. Methods: Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room. Results: One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=<0.05. Construct validity for both technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=<0.05. Conclusions: Our study demonstrates that technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations.

Chang, Avril; Vincent, Charles

2006-01-01

290

Increased risk of hepatocellular carcinoma after cholecystectomy  

PubMed Central

Background: The association between gall bladder removal (cholecystectomy) and hepatocellular carcinoma warrants investigation. An increased intrahepatic bile duct pressure following cholecystectomy might cause chronic inflammation in the surrounding liver tissue, which might induce cancer development. Methods: A nationwide Swedish population-based cohort study in 1965–2008 included 345?251 patients undergoing cholecystectomy because of gallstone. The number of observed hepatocellular carcinoma cases was divided by the expected number, calculated from the corresponding background Swedish population, thus providing standardised incidence ratios (SIRs) with 95% confidence intervals (CIs). Results: During follow-up of 4?854?969 person-years, 333 new cases of hepatocellular carcinoma were identified, rendering an overall increased risk (SIR 1.24, 95% CI: 1.11–1.38). The risk increased with longer follow-up (P for trend=0.003). Among patients who underwent cholecystectomy 30–43 years earlier, SIR was 2.00 (95% CI: 1.32–2.87). The results were similar after exclusion of 15?634 patients with any recorded risk factor, that is, diabetes, obesity, hepatitis, liver cirrhosis, alcoholism, or blood transfusion. Conclusion: Cholecystectomy might be associated with a long-term increased risk of hepatocellular carcinoma.

Lagergren, J; Mattsson, F; El-Serag, H; Nordenstedt, H

2011-01-01

291

Hyperkinetic gallbladder: an indication for cholecystectomy?  

PubMed

Cholecystectomy may benefit children with biliary colic without stones on ultrasound (US) or low ejection fraction on cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Children with symptomatic biliary colic and abnormal HIDA scan, specifically those with high ejection fractions, may benefit from cholecystectomy. All patients younger than 18 years old undergoing cholecystectomy from 2008 to 2012 in our practice were reviewed. Patients with a negative US and CCK-HIDA ejection fractions 80 per cent or greater were included in the study. Patient data were extracted from charts, whereas postoperative symptoms were obtained by phone interviews. Of 174 patients who underwent cholecystectomy, 12 (7%) met study criteria. All patients (12 of 12) had evidence of cholecystitis on the final pathology note. All 11 patients contacted had relief of colic after gallbladder removal with a mean follow-up of 16 months. A subset of pediatric patients with high ejection fractions on CCK-HIDA and symptomatic biliary colic may have symptomatic relief with cholecystectomy. PMID:24069981

Lindholm, Erika B; Alberty, J Brannon; Hansbourgh, Faith; Upp, James R; Lopoo, John

2013-09-01

292

Portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy.  

PubMed

A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population. PMID:12677588

Brink, Jeromy S; Brown, Amanda K; Palmer, Brian A; Moir, Christopher; Rodeberg, David R

2003-04-01

293

Cholecystectomy. The impact of socioeconomic change.  

PubMed Central

The impact of our evolving health care system on a commonly performed surgical procedure, cholecystectomy, was assessed in a county-subsidized and private university hospital setting. Although condition on admission, use of resources, and outcome were unchanged in the private setting between 1980 and 1988, significant differences were noted among the largely uninsured patients at the county facility during this same time interval. There was a significant increase in the acuity of illness among patients undergoing cholecystectomy at the county hospital in 1988 as compared with 1980. These data suggest that alterations in reimbursement strategies and allocation of resources are significantly impacting on patient care, particularly in nonprivate health care facilities.

Saunders-Kirkwood, K D; Aizen, B; Thompson, J E; Zinner, M J; Cates, J A; Bennion, R; Gill, J; Boudi, F; Roslyn, J J

1992-01-01

294

[Laparoscopic adrenalectomy].  

PubMed

The authors performed three left and one right sided laparoscopic adrenalectomies between 3rd April and 8th August 1997. The indication of surgery was hormonally active cortical adenoma of about 2 cm size in three cases, a 6 cm large hormonally inactive tumour in one case respectively. For the operation on the left side three, on the right side four trocars with 11 mm diameter was used. The duration of the operations was between 115 and 220 min. The patients left one the second or third postoperative day, no complication was observed. The authors' opinion based on both literature data and their own experience is that laparoscopic approach to adrenalectomies is the method of choice today. PMID:9702083

Horányi, J; Tihanyi, T; Darvas, K; Rácz, K; Fütö, L

1998-07-12

295

[Laparoscopic splenectomy].  

PubMed

To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail. PMID:9586193

Reck, T; Köckerling, F; Scheuerlein, H; Hohenberger, W

1998-01-01

296

Laparoscopic Instrumentation  

Microsoft Academic Search

\\u000a Laparoscopic instrumentation continues to evolve towards smaller, more reliable, and better ergonomic devices, with a larger\\u000a variety of choices. Since the first edition of this textbook, subtle improvements are readily apparent in existing devices\\u000a as first-generation instruments progress towards later-generation models. New technology exists to allow procedures to be\\u000a performed with fewer complications. Combined with refinements in techniques, new and

Patrick S. Lowry

297

Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy.  

PubMed

The diagnosis of acute cholecystitis in critically ill patients carries a high mortality rate. Although decompression and drainage of the gallbladder through a cholecystostomy tube may be used as a temporary treatment of acute cholecystitis in this population, there is still some debate about the management of the tube and the subsequent need for a cholecystectomy. This series evaluates the clinical course and outcomes of critically ill patients who underwent the insertion of cholecystostomy tubes for the initial treatment of acute cholecystitis. This is a retrospective review of critically ill patients admitted to the hospital intensive care unit who were diagnosed with acute cholecystitis and underwent a cholecystostomy tube as a temporary treatment for the disease. Patients were identified through the Greenville Hospital System electronic medical records coding database. Medical records were reviewed for demographic data, diagnoses, imaging, complications, and outcomes. From January 2002 through June 2008, 50 patients were identified for the study. The mean age was 72 +/- 11 years, and the majority (66%) were men. The following comorbidities were found: severe cardiovascular disease (40 patients), respiratory failure (30 patients), and multisystem organ dysfunction (30 patients). The mean intensive care unit length of stay (LOS) was 16 +/- 9 days, and the mean hospital LOS was 28 +/- 27 days. At 30 days, the morbidity associated with the cholecystostomy tube itself was 4 per cent, but overall in-hospital morbidity and mortality rates were 62 and 50 per cent, respectively. Of the 25 patients who survived longer than 30 days, 12 retained their cholecystostomy tubes until they underwent cholecystectomy (four open, seven laparoscopic). All of the remaining 13 patients had their cholecystostomy tubes removed, and eight developed recurrent cholecystitis. Of these patients with recurrent of cholecystitis, five had cholecystectomy or repeat cholecystostomy, but the remaining three patients died. Although this is a small patient population, these data suggest that, in critically ill patients, cholecystostomy tubes should remain in place until the patient is deemed medically suitable to undergo cholecystectomy. Removal of the cholecystostomy tube without subsequent cholecystectomy is associated with a high incidence of recurrent cholecystitis and devastating consequences. PMID:20698375

Morse, Bryan C; Smith, J Brandon; Lawdahl, Richard B; Roettger, Richard H

2010-07-01

298

Hematocele After Laparoscopic Appendectomy  

PubMed Central

Background: Laparoscopic appendectomy is one of the most common laparoscopic surgeries performed. We report an unusual complication of hematocele after laparoscopic appendectomy. Case Description: A 48-y-old male presented with swelling and discomfort in his right scrotum 11 d after he underwent laparoscopic appendectomy for acute appendicitis. Before the surgery, he had no scrotal swelling or inguinal hernia.

Bhullar, Jasneet Singh; Subhas, Gokulakrishna; Mittal, Vijay K.

2012-01-01

299

Single-Incision Laparoscopic Colorectal Surgery, Experience with 50 Consecutive Cases  

Microsoft Academic Search

Background  Single-incision laparoscopic surgery (SILS) is one of the most recent developments in laparoscopic surgery. Having proven\\u000a its effectiveness in cholecystectomy and appendectomy, the feasibility of SILS in more advanced surgery, such as hemicolectomy\\u000a and low anterior resection, is now a point of discussion.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This study reports on the results of the first 50 SILS colorectal operations at our institution. Twenty

Peter B. van den Boezem; Colin Sietses

300

Computer-assisted laparoscopic splenectomy with the da Vinci surgical robot.  

PubMed

Laparoscopic splenectomy has become the standard of care for the surgical treatment of idiopathic thrombocytopenic purpura (ITP). The minimally invasive approach to splenic disorders such as ITP clearly results in the same benefits to the patients as have been demonstrated with the laparoscopic cholecystectomy techniques. New technologies in minimally invasive surgery have resulted in the development of robotic devises that assist the surgeon during the procedures. Robotic surgery is in its infancy at this point in time. Herein, we report a splenectomy performed with the assistance of the da Vinci surgical robot. With advancement of technology, robotic systems will play an integral role in future minimally invasive surgery. PMID:12184899

Chapman, William H H; Albrecht, Robert J; Kim, Victor B; Young, James A; Chitwood, W Randolph

2002-06-01

301

A novel application for single-incision laparoscopic surgery (SILS): SIL jejunostomy feeding tube placement  

Microsoft Academic Search

Background  Single-incision laparoscopic surgery (SILS) is rapidly gaining popularity as the practical alternative to natural orifice\\u000a transluminal endoscopic surgery (NOTES). Although SILS achieves essentially the same goal as NOTES (a nearly invisible scar\\u000a in the umbilicus), it does not carry the significant potential risks of a transluminal approach. The SILS approach has been\\u000a most commonly described for cholecystectomy and appendectomy. The

S. Sameer MohiuddinC; C. Erik Anderson

2011-01-01

302

Management of common bile duct stone late after laparoscopic Roux-en-Y gastric bypass for obesity.  

PubMed

Rapid weight loss following Roux-en-Y gastric bypass (RYGBP) for the treatment of obesity can increase the incidence of cholelithiasis formation. Nevertheless, routine simultaneous cholecystectomy at the time of bariatric surgery remains controversial. However, in case of delayed occurrence of common bile duct (CBD) stones, the difficulty to reach endoscopically the biliary tract after RYGBP should be kept in mind. We here report the case of a patient who presented with CBD stones seven years after gastric banding followed five years later by RYGBP without associated cholecystectomy. Our approach of transgastric laparoscopic assisted endoscopic retrograde cholangiopancreaticography followed by sphincterotomy and balloon stones extraction is illustrated. PMID:20184081

Malherbe, V; Badaoui, A; Huybrecht, H; De Ronde, T; Michel, L; Rosière, A

303

Proving the Value of Simulation in Laparoscopic Surgery  

PubMed Central

Objective: To assess the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) physical laparoscopic simulator for construct and predictive validity and for its educational utility. Summary Background Data: MISTELS is the physical simulator incorporated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in their Fundamentals of Laparoscopic Surgery (FLS) program. MISTELS’ metrics have been shown to have high interrater and test-retest reliability and to correlate with skill in animal surgery. Methods: Over 200 surgeons and trainees from 5 countries were assessed using MISTELS in a series of experiments to assess the validity of the system and to evaluate whether practicing MISTELS basic skills (transferring) would result in skill acquisition transferable to complex laparoscopic tasks (suturing). Results: Face validity was confirmed through questioning 44 experienced laparoscopic surgeons using global rating scales. MISTELS scores increased progressively with increasing laparoscopic experience (n = 215, P < 0.0001), and residents followed over time improved their scores (n = 24, P < 0.0001), evidence of construct validity. Results in the host institution did not differ from 5 beta sites (n = 215, external validity). MISTELS scores correlated with a highly reliable validated intraoperative rating of technical skill during laparoscopic cholecystectomy (n = 19, r = 0.81, P < 0.0004; concurrent validity). Novice laparoscopists were randomized to practice/no practice of the transfer drill for 4 weeks. Improvement in intracorporeal suturing skill was significantly related to practice but not to baseline ability, career goals, or gender (P < 0.001). Conclusion: MISTELS is a practical and inexpensive inanimate system developed to teach and measure technical skills in laparoscopy. This system is reliable, valid, and a useful educational tool.

Fried, Gerald M.; Feldman, Liane S.; Vassiliou, Melina C.; Fraser, Shannon A.; Stanbridge, Donna; Ghitulescu, Gabriela; Andrew, Christopher G.

2004-01-01

304

Cholecystectomy. The impact of socioeconomic change.  

PubMed

The impact of our evolving health care system on a commonly performed surgical procedure, cholecystectomy, was assessed in a county-subsidized and private university hospital setting. Although condition on admission, use of resources, and outcome were unchanged in the private setting between 1980 and 1988, significant differences were noted among the largely uninsured patients at the county facility during this same time interval. There was a significant increase in the acuity of illness among patients undergoing cholecystectomy at the county hospital in 1988 as compared with 1980. These data suggest that alterations in reimbursement strategies and allocation of resources are significantly impacting on patient care, particularly in nonprivate health care facilities. PMID:1558411

Saunders-Kirkwood, K D; Aizen, B; Thompson, J E; Zinner, M J; Cates, J A; Bennion, R; Gill, J; Boudi, F; Roslyn, J J

1992-04-01

305

Development of explicit criteria for cholecystectomy  

PubMed Central

Objective: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cholecystectomy. New diagnostic and treatment techniques have been developed in the last decade, so an updated appropriateness of indications tool was developed for cholecystectomy in patients with non-malignant diseases. The validity and reliability of panel results using this tool were tested. Methods: Criteria were developed using a modified Delphi panel judgement process. The level of agreement between the panellists (six gastroenterologists and six surgeons) was analysed and the ratings were compared with those of a second different panel using weighted kappa statistics. Results: The results of the main panel were presented as a decision tree. Of the 210 scenarios evaluated by the main panel in the second round, 51% were found appropriate, 26% uncertain, and 23% inappropriate. Agreement was achieved in 54% of the scenarios and disagreement in 3%. Although the gastroenterologists tended to score fewer scenarios as appropriate, as a group they did not differ from the surgeons. Comparison of the ratings of the main panel with those of a second panel resulted in a weighted kappa statistic of 0.75. Conclusions: The parameters tested showed acceptable validity and reliability results for an evaluation tool. These results support the use of this algorithm as a screening tool for assessing the appropriateness of cholecystectomy.

Quintana, J; Cabriada, J; d Lopez; Varona, M; Oribe, V; Barrios, B; Arostegui, I; Bilbao, A

2002-01-01

306

Cholecystogastric fistula: laparoscopic repair.  

PubMed

We describe a patient with a cholecystogastric fistula treated by the laparoscopic approach. The use of intracorporeal suturing allows laparoscopic management of cholecystogastric fistulae without the need for an endoscopic transecting stapler. PMID:11525375

Prasad, A; Kapur, R

2001-08-01

307

Role of pre-operative dexamethasone as prophylaxis for postoperative nausea and vomiting in laparoscopic surgery  

PubMed Central

Introduction: Laparoscopic surgery provides tremendous benefits to patients, including faster recovery, shorter hospital stay and prompt return to normal activities. Despite the minimally invasive nature of laparoscopy, high incidence of postoperative nausea and vomiting remains a major cause for morbidity. The aim of the present study was to investigate whether preoperative Dexamethasone can reduce PONV in patients undergoing laparoscopic Surgery. Materials and Methods: The study included 200 patients undergoing laparoscopic cholecystectomy. We divided the patients into two groups; one group received preoperative Dexamethasone (group 1) and the other group received Ondansetron (group 2). After surgery, patients were observed for any episode of nausea or vomiting, or whether the patient required any anti-emetic drug in the postoperative period. Results: The two groups, (Dexamethasone and Ondansetron) were comparable in outcome, in terms of post-operative nausea and vomiting, in patients undergoing laparoscopic cholecystectomy. In group I, 24% of patients had nausea, as compared to 30% in group II (P=0.2481). Similarly, 12% of patients in group I and 18% of patients in group II had vomiting (P=0.3574). Conclusion: We conclude that, preoperative intravenous low dose Dexamethasone reduces the incidence of PONV and is comparable to intravenous Ondansetron.

Gupta, P; Khanna, J; Mitramustafi, A K; Bhartia, V K

2006-01-01

308

Challenges of Laparoscopic Surgery  

NSDL National Science Digital Library

Students teams use a laparoscopic surgical trainer to perform simple laparoscopic surgery tasks (dissections, sutures) using laparoscopic tools. Just like in the operating room, where the purpose is to perform surgery carefully and quickly to minimize patient trauma, students' surgery time and mistakes are observed and recorded to quantify their performances. They learn about the engineering component of surgery.

Integrated Teaching And Learning Program

309

A Case of Emphysematous Cholecystitis Managed by Laparoscopic Surgery  

PubMed Central

Background: Emphysematous cholecystitis is a rare condition caused by ischemia of the gallbladder wall with secondary gas-producing bacterial proliferation. The pathophysiology and epidemiology of this condition differ from that in gallstone-related acute cholecystitis. This report illustrates a case of emphysematous cholecystitis successfully treated by laparoscopic surgery. Methods: An 83-year-old female patient was admitted to the hospital with acute abdominal syndrome. Clinical examination and blood tests suggested acute cholecystitis. Plain radiography revealed a circular gas pattern in the right upper quadrant suggestive of emphysematous cholecystitis. Subsequent computed tomography confirmed the presence of gas in the gallbladder wall and a gas-fluid level within the organ. Results: Emergency laparoscopic cholecystectomy was successfully performed during which bubbling of the gall-bladder wall was observed. Intraoperative cholangiography revealed no bile duct stones or biliary obstruction. The patient made an unremarkable recovery from surgery with no postoperative complications or admission to the intensive care unit. Pathological analysis revealed full-thickness infarctive necrosis of the gallbladder. Bacterial cultures grew Clostridium perfringens. Conclusions: This case illustrates a typical case of emphysematous cholecystitis successfully treated by laparoscopic surgery. It contributes to suggestions from other reports that this condition can be safely treated by the laparoscopic approach.

Lunca, Sorinel; Vix, Michel; Marescaux, Jacques

2005-01-01

310

The effect of cholecystectomy on bile salt metabolism  

Microsoft Academic Search

Isotopic bile salt studies have been performed in 13 cholecystectomy patients and 10 matched controls using labelled taurocholate and deoxycholic acid. Cholecystectomy subjects have reduced pools of both primary bile salts, cholate and chenodeoxycholate, while the deoxycholate pool remains normal in size. As a result of these changes, the total bile salt pool is reduced to almost half its normal

E. W. Pomare; K. W. Heaton

1973-01-01

311

Transumbilical laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis.  

PubMed

Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass-TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach. PMID:23104389

Fernández, José Ignacio; Ovalle, Cristian; Farias, Carlos; de la Maza, Jaime; Cabrera, Carolina

2013-01-01

312

Laparoscopic bile duct injury: understanding the psychology and heuristics of the error.  

PubMed

Bile duct injury is an important unsolved problem of laparoscopic cholecystectomy, occurring with unacceptable frequency even in the hands of experienced surgeons. This suggests that a systemic predisposition to the injury is intrinsic to cholecystectomy and indicates that an analysis of the psychology and heuristics of surgical decision-making in relation to duct identification may be a guide to prevention. Review of published reports on laparoscopic bile duct injury from 1997 to 2007 was carried out. An analysis was also carried out of the circumstances of the injuries in 49 patients who had transection of an extrahepatic bile duct and who were referred for reconstruction or were assessed in a medicolegal context. Special emphasis was placed on identifying the possible psychological aspects of duct misidentification. Review of published work showed an emphasis on the technical aspects of correct identification of the cystic duct, with few papers addressing the heuristics and psychology of surgical decision-making during cholecystectomy. Duct misidentification was the cause of injury in 42 out of the 49 reviewed patients (86%). The injury was not recognized at operation in 70% and delay in recognition persisted into the postoperative period in 57%. Underestimation of risk, cue ambiguity and visual misperception ('seeing what you believe') were important factors in misidentification. Delay in recognition of the injury is a feature consistent with cognitive fixation and plan continuation, which help construct and sustain the duct misidentification during the operation and beyond. Changing the 'culture' of cholecystectomy is probably the most effective strategy for preventing laparoscopic bile duct injury, especially if combined with new technical approaches and an understanding of the heuristics and psychology of the duct misidentification error. Training of surgeons for laparoscopic cholecystectomy should emphasize the need to be alert for cues that the incorrect duct is being dissected or that a bile duct injury might have occurred. Surgeons may also be trained to accept the need for plan modification, to seek cues that refute a given hypothesis and to apply 'stopping rules' for modifying or converting the operation. PMID:19087053

Dekker, Sidney W A; Hugh, Thomas B

2008-12-01

313

Laparoscopic Doppler Technology in Laparoscopic Renal Surgery  

PubMed Central

Background and Objectives: Laparoscopic Doppler technology has previously been reported to help identify vasculature during laparoscopy. Recently, we published our initial experience with this technology during laparoscopic radical nephrectomy, laparoscopic nephroureterectomy, laparoscopic partial nephrectomy, and robotic-assisted laparoscopic pyeloplasty. We now present a prospective, pilot evaluation of the Doppler probe for these procedures. Methods: A laparoscopic Doppler probe was used in the above laparoscopic renal surgeries in 50 patients. Anatomic findings, Doppler survey time, dissection time, operative time, estimated blood loss, changes in management, subjective time saved/utility, technical difficulties, clinical complications, and ease of use were prospectively recorded. Results: Mean Doppler survey time was 1.77 minutes. Mean hilar dissection time was 9.25 minutes. Eight accessory vessels were not seen on preoperative imaging in 7 patients (17%). In 3 cases of RALP, Doppler rectified preoperative imaging in detecting a crossing vessel. The probe altered management in 16% of patients, subjectively saved time in 78% of patients, and had 100% concordance with dissection. There were no complications but 2 technical failures. Conclusion: The probe is quick, safe, easy to use, and has perfect concordance with surgical dissection. Randomized comparison with and without Doppler assistance is necessary to confirm the utility of this technology.

Perlmutter, Mark A.; Hyams, Elias S.

2009-01-01

314

Laparoscopic proctectomy: oncologic considerations.  

PubMed

The role of laparoscopic proctectomy in rectal cancer has not clearly been defined. Publications on long-term outcomes after laparoscopic proctectomy is lacking and there is a wide variation of practice patterns of rectal cancer management. Current data supports the feasibility of laparoscopic proctectomy for rectal cancer but due to surgeon, patient and tumor related factors open technique may be favored. Current series suggest that laparoscopic proctectomy can be performed with similar oncologic adequacy with regards to, circumferential resection margin, distal margin, local recurrence and quality of life. Ongoing trials will provide evidence clarifying the role of laparoscopic proctectomy in rectal cancer. Until then, high-level laparoscopic skills and meticulous preoperative evaluation of both patient and tumor can identify appropriate candidates. PMID:22678308

Asgeirsson, Theodor; Delaney, Conor P

2012-06-01

315

Laparoscopic herniorrhaphy in children  

Microsoft Academic Search

  Background: We report our clinical experience with 403 inguinal hernias in 279 children. They were treated via a purely laparoscopic\\u000a approach using 2-mm instruments, obviating the need for a groin incision. Methods: Laparoscopic herniorrhaphy was performed\\u000a in children ages 4 days to 15 years. A 5-mm laparoscope was inserted through the umbilicus, and two 2-mm needle holders were\\u000a inserted through

C. M. Gorsler; F. Schier

2003-01-01

316

Laparoscopic reconstructive urology  

PubMed Central

Objective: Laparoscopic reconstructive urology is undergoing rapid change. We review the current status of laparoscopic reconstructive urology, with particular respect to pyeloplasty and reconstructive ureteric surgery. Methods: An extensive Medline search of reconstructive laparoscopic procedures was undertaken. The initial reports and large series reports of a range of procedures was examined and summarised. The most commonly practised procedure within this remit is laparoscopic pyeloplasty. Several series of over 100 patients have been published. Success rates average over 90% for laparoscopic pyeloplasty with a low complication rate. Much less common laparoscopic reconstructive urological procedures include ureteric re-implantation, Boari flap, urinary diversion and transuretero-ureterostomy. The results of these are encouraging. Conclusions: Laparoscopic pyeloplasty may be safely performed by either the transperitoneal or retroperitoneal routes with excellent results. It should be considered the “gold standard” for the management of UPJ obstruction, especially in those patients with significant hydronephrosis, renal impairment or a crossing vessel. Laparoscopic ureteric reimplantation, Boari flap, urinary diversion and transuretero-ureterostomy have been performed by experienced laparoscopic urologists with encouraging results.

Murphy, Declan; Challacombe, Ben; Rane, Abhay

2005-01-01

317

Laparoscopic transperitoneal pyeloplasty.  

PubMed

Laparoscopic pyeloplasty is a first-line option for the management of ureteropelvic junction obstruction. It has a greater success rate than endopyelotomy and is associated with a shorter and less intense convalescence than open surgical pyeloplasty. The technique is well established and reproducible, although the procedure is more difficult in certain situations, such as after a previous pyeloplasty. Because laparoscopic suturing is needed, it is considered an advanced laparoscopic procedure. Suturing devices can facilitate suturing, but they are not optimal for all repairs. This article and the accompanying video summarize the preoperative, intraoperative, and postoperative considerations for laparoscopic pyeloplasty. PMID:21235382

Wolf, J Stuart

2011-01-15

318

Single-Incision Laparoscopic Surgery--Hype or Reality: A Historical Control Study  

PubMed Central

Introduction: Single-incision laparoscopic surgery (SILS) is a “new” method to perform “old” operations. Though SILS has been referred to by many names, for the sake of this paper, any procedure done laparoscopically through one incision (regardless of the number of ports or working channels) will be considered a SILS procedure. This brief review will discuss the history of SILS, current applications, and potential pitfalls. Methods: To explore the outcomes of SILS cholestectomy in a community setting, we conducted a historical control study comparing, through retrospective review, 50 laparoscopic cholecystectomies to 50 SILS cholecystectomies, all performed by one of the authors (DT). Results: Of the 50 patients selected, 12 patients had cholangiograms performed at the same time. The mean operative time for all cases was 50.4 minutes (range 31 minutes to 108 minutes). For the noncholangiogram group, the mean operative time was 48 minutes whereas it was 57.7 minutes for patients requiring a cholangiogram. Mean estimated blood loss was 28 mL. There was a 20% “conversion” rate (n = 10): 4 with an additional trocar, 5 with a 4-port technique, 1 with an open procedure. Discussion: We conclude that, although SILS is a relatively new procedure for general surgery, we feel it is here to stay. Although the only documented benefit is cosmetic, SILS is equivalent to conventional laparoscopy in all other respects.

Saidy, Maryam N; Tessier, Michele; Tessier, Deron

2012-01-01

319

The CHOLEGAS study: multicentric randomized, blinded, controlled trial of gastrectomy plus prophylactic cholecystectomy versus gastrectomy only, in adults submitted to Gastric cancer surgery with curative intent  

PubMed Central

Background The incidence of gallstones and gallbladder sludge is known to be higher in patients after gastrectomy than in general population. This higher incidence is probably related to surgical dissection of the vagus nerve branches and the anatomical gastrointestinal reconstruction. Therefore, some surgeons perform routine concomitant cholecystectomy during standard surgery for gastric malignancies. However, not all the patients who are diagnosed to have cholelithiasis after gastric cancer surgery will develop symptoms or require additional surgical treatments and a standard laparoscopic cholecystectomy is feasible even in those patients who underwent previous gastric surgery. At the present, no randomized study has been published and the decision of gallbladder management is left to each surgeon preference. Design The study is a randomized controlled investigation. The study will be performed in the General and Oncologic Surgery, Department of Oncology – Azienda Ospedaliero-Universitaria Careggi – Florence – Italy, a large teaching institution, with the participation of all surgeons who accept to be involved in, together with other Italian Surgical Centers, on behalf of the GIRCG (Italian Research Group for Gastric Cancer). The patients will be randomized into two groups: in the first group the patient will be submitted to prophylactic cholecystectomy during standard surgery for curable gastric cancer (subtotal or total gastrectomy), while in the second group he/she will be submitted to standard gastric surgery only. Trial Registration ClinicalTrials.gov ID. NCT00757640

Farsi, Marco; Bernini, Marco; Bencini, Lapo; Miranda, Egidio; Manetti, Roberto; de Manzoni, Giovanni; Verlato, Giuseppe; Marrelli, Daniele; Pedrazzani, Corrado; Roviello, Francesco; Marchet, Alberto; Cristadoro, Luigi; Gerard, Leonardo; Moretti, Renato

2009-01-01

320

Laparoscopic total abdominal colectomy  

Microsoft Academic Search

The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included

Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman

1992-01-01

321

Laparoscopic entry and exit.  

PubMed

Minimal access surgery has emerged as an acceptable means of performing therapeutic and diagnostic surgical procedures. Although the gynecologist has utilized the laparoscope for several decades, only recently has laparoscopic surgery gained increased acceptance in the general surgical and urologic community. The number of laparoscopic procedures being performed routinely is now extensive and growing rapidly. It appears that the critical step in performing laparoscopic surgery is the establishment of pneumoperitoneum and the placement of the trocars. This initial part of the procedure when performed properly ensures safe and reliable access allowing the procedure to commence. Difficulties with this part of the procedure may preclude the operative procedure and more importantly may result in potentially severe injuries. Therefore a detailed discussion of the method of performing laparoscopic entry and exit will provide the urologist with the essentials to perform safe and successful laparoscopy. PMID:8239733

Oshinsky, G S; Badlani, G H; Smith, A D

1993-09-01

322

Novel hybrid (magnet plus curve grasper) technique during transumbilical cholecystectomy: initial experience of a promising approach.  

PubMed

Abstract Objectives: The use of magnets in transumbilical cholecystectomy (TUC) improves triangulation and achieves an optimal critical view. Nonetheless, the tendency of the magnets to collide hinders the process. In order to simplify the surgical technique, we developed a hybrid model with a single magnet and a curved grasper. Patients and Methods: All TUCs performed with a hybrid strategy in our pediatric population between September 2009 and July 2012 were retrospectively reviewed. Of 260 surgical procedures in which at least one magnet was used, 87 were TUCs. Of those, 62 were hybrid: 33 in adults and 29 in pediatric patients. The technique combines a magnet and a curved grasper. Through a transumbilical incision, we placed a 12-mm trocar and another flexible 5-mm trocar. The laparoscope with the working channel used the 12-mm trocar. The magnetic grasper was introduced to the abdominal cavity using the working channel to provide cephalic retraction of the gallbladder fundus. Across the flexible trocar, the assistant manipulated the curved grasper to mobilize the infundibulum. The surgeon operated through the working channel of the laparoscope. Results: In this pediatric population, the mean age was 14 years (range, 4-17 years), and mean weight was 50?kg (range, 18-90?kg); 65% were girls. Mean operative time was 62 minutes. All procedures achieved a critical view of safety with no instrumental collision. There were no intraoperative or postoperative complications. The hospital stay was 1.4±0.6 days, and the median follow-up was 201 days. Conclusions: A hybrid technique, combining magnets and a curved grasper, simplifies transumbilical surgery. It seems feasible and safe for TUC and potentially reproducible. PMID:24004270

Millan, Carolina; Bignon, Horacion; Bellia, Gaston; Buela, Enrique; Rabinovich, Fernando; Albertal, Mariano; Martinez Ferro, Marcelo

2013-09-04

323

Laparoscopic bile duct injuries. Risk factors, recognition, and repair.  

PubMed

Records of 11 patients undergoing biliary reconstruction after laparoscopic cholecystectomy are reviewed. Ductal injuries resulted from failure to define the anatomy of Calot's triangle. Risk factors include scarring, acute cholecystitis, and obesity. Presenting findings included anorexia, ileus, failure to thrive, pain, ascites, and jaundice. All patients required hepaticojejunostomies, which were multiple and above the hepatic bifurcation in four patients. Given the extensive nature of these injuries and the frequent need for intrahepatic anastomosis and early stenosis of repairs by referring physicians, we recommend reconstruction be undertaken by an experienced hepatobiliary surgeon. To avoid injuries, a greater appreciation of risk factors and anatomic distortion and variance and strict adherence to principles of dissection and identification of anatomic structures are suggested. The use of cholangiography and a low threshold for conversion to the open procedure are advised. PMID:1533509

Rossi, R L; Schirmer, W J; Braasch, J W; Sanders, L B; Munson, J L

1992-05-01

324

Cholecystectomy and risk of laryngeal and pharyngeal cancer.  

PubMed

Duodeno-gastro-esophageal reflux of bile might cause laryngeal and pharyngeal cancer, but more research is required. Since cholecystectomy is followed by an increased risk such reflux, the risk of developing laryngeal or pharyngeal cancer after cholecystectomy was addressed. A population-based cohort study was conducted in Sweden during the period 1965-2008. The number of laryngeal or pharyngeal cancer cases observed in a large cohort of cholecystectomized patients was compared with the expected number, calculated from the entire Swedish population of corresponding age, gender and calendar year. Risk of laryngeal or pharyngeal cancer was calculated as standardized incidence ratio (SIR) with 95% confidence interval (CI). The cholecystectomy cohort included 345,251 patients who were followed up for 1-43 years and contributed 4,854,969 person-years at risk. The 192 new cases of laryngeal cancer and the 175 cases of pharyngeal cancer were not greater than the expected, providing SIR 0.99 (95% CI 0.85-1.14) and SIR 1.06 (95% CI 0.91-1.23), respectively. A longer latency period after cholecystectomy was not associated with any increased risk of any of these tumors. No differences between age groups or sexes were detected. Analyses restricted to verified squamous-cell carcinomas revealed similar results. In conclusion, cholecystectomy does not appear to be followed by any increased risk of laryngeal or pharyngeal cancer. PMID:21717451

Lagergren, Jesper; Mattsson, Fredrik

2011-08-24

325

STATIN USE AND THE RISK OF CHOLECYSTECTOMY IN WOMEN  

PubMed Central

Background Statins can reduce biliary cholesterol secretion independently of their ability to inhibit cholesterol synthesis. They also prevent formation of gallstones in animal studies, although the effect of statins on human gallstone disease has been controversial. Methods We examined the relationship between use of statins and the risk of cholecystectomy in a cohort of U.S. women. As part of the prospective Nurses’ Health Study, participants biennially reported history of gallstone disease and whether they had undergone cholecystectomy. Women also reported lifetime use of statins retrospectively in 2000. We conducted a retrospective analysis of statin using data collected in 2000, to define use from 1994 forward, and a prospective analysis for general lipid-lowering drugs from 1994 to 2004. Results In the statin analysis we ascertained 2,479 cases of cholecystectomy during 305,197 person-years of follow-up. The multivariate relative risk for current statin users, compared with nonusers, was 0.82 (95% confidence interval, 0.70 to 0.96). In the analysis of general cholesterol-lowering drugs, we ascertained 3,420 cases of cholecystectomy during 511,411 person-years of follow-up. Compared with nonusers, the multivariate relative risk for current users of general cholesterol-lowering drugs, mostly statins in this cohort, was 0.88 (95% confidence interval, 0.79 to 0.98). Conclusions Statin use appears to reduce the risk of cholecystectomy in women.

Tsai, Chung-Jyi; Leitzmann, Michael F.; Willett, Walter C.; Giovannucci, Edward L.

2013-01-01

326

Laparoscopic lateral pancreaticojejunostomy  

Microsoft Academic Search

Background  Lateral pancreaticojejunostomy is considered as the standard surgery for chronic pancreatitis. Yet there are very few reports\\u000a of this procedure being done laparoscopically. We present our experience with laparoscopic lateral pancreaticojejunostomy\\u000a till date and describe our technique.\\u000a \\u000a \\u000a \\u000a Material and method  Since 1997, we have done 12 laparoscopic lateral pancreatojejunostomies. There were 9 females and 3 males and the average\\u000a age was

C. Palanivelu; R. Shetty; K. Jani; P. S. Rajan; K. Sendhilkumar; R. Parthasarthi; V. Malladi

2006-01-01

327

Laparoscopic Duhamel procedure  

Microsoft Academic Search

Background: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of\\u000a Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized\\u000a laparoscopically. A standard posterior colo-anal

P. de Lagausie; D. Berrebi; G. Geib; G. Sebag; Y. Aigrain

1999-01-01

328

Single incision laparoscopic surgery ovarian cystectomy in large benign ovarian cysts using conventional instruments  

PubMed Central

We describe a technique for the management of large benign ovarian cysts by single incision laparoscopic surgery (SILS) through the umbilicus. The paucity of intra-abdominal working space in large ovarian cysts poses a technical challenge. Moreover, difficult convergence of operating instruments and competition for operating space outside the abdomen during the SILS makes the procedure quite demanding, especially with the conventional instruments. The concept of providing traction by taking sutures from the abdominal wall, as done in SILS laparoscopic cholecystectomy, was applied for SILS cystectomy in large ovarian cysts. Two sutures taken through the abdominal wall and then through the cyst wall provide excellent traction and “hang” the cyst from the abdominal wall, making it convenient to dissect and operate. This technique demonstrates that SILS ovarian cystectomy is feasible, safe and technically unchallenging even in large benign ovarian cysts.

Garg, Pankaj; Misra, Swapna; Thakur, Jai Deep; Song, Jeremy

2011-01-01

329

Towards laparoscopic tissue aspiration.  

PubMed

The soft tissue aspiration experiment has been further developed for application during laparoscopic surgery. The new setup has been tested and validated under lab-conditions and came then to in vivo operation. It is to our knowledge the first time ever a mechanical experiment has been performed under laparoscopic conditions on the human, which enables determining corresponding constitutive model equations. As most important results, the feasibility of laparoscopic tissue aspiration has been demonstrated and, based on an ad hoc parameter for the tissue stiffness, the liver and the stomach gave significantly different responses. Furthermore, the determined constitutive behavior for one healthy human liver was in line with results obtained from tissue aspiration during open surgery. Eventually, laparoscopic tissue aspiration might qualify as minimally invasive testing method for tactile feedback systems. The presented results are preliminary and more research is required. PMID:23876854

Hollenstein, Marc; Bugnard, Guillaume; Joos, Renzo; Kropf, Saskia; Villiger, Peter; Mazza, Edoardo

2013-06-19

330

Laparoscopic transabdominal lateral adrenalectomy.  

PubMed

Laparoscopic adrenalectomy is a mainstay of operative options for adrenal tumors and allows surgeons to perform adrenalectomies with less morbidity, less post-operative pain, and shorter hospital stays. The literature has demonstrated its efficacy to be equal to open adrenalectomy in most cases. With regard to malignant primary and metastatic lesions, controversy still remains, however, consideration of a laparoscopic approach for smaller, well circumscribed and non-invasive lesions is reasonable. During any laparoscopic resection, when there is doubt about the ability to safely remove the lesion with an intact capsule, conversion to an open approach should be considered. The primary goal of a safe and complete oncologic resection cannot be compromised. For most benign lesions, laparoscopic approaches are safe and feasible and conversion to an open approach is necessary only for lesions where size limits the ability of a minimally invasive resection. PMID:22933307

Bickenbach, Kai A; Strong, Vivian E

2012-08-29

331

Laparoscopic pancreatic resections.  

PubMed

The last decade has seen an increase in the application of minimally invasive surgical procedures to the management of pancreatic disease. Laparoscopic pancreatic surgery is an advanced laparoscopic procedure with a significant learning curve. It should be considered only by surgeons with extensive experience in open pancreatic surgery who possess advanced laparoscopic 'skills. Early reports suggest that laparoscopic pancreatic surgery can be accomplished with acceptable morbidity and mortality for the resection of small benign and low-grade malignant lesions in the body and tail of the pancreas and for the internal drainage of pancreatic pseudocysts. Its role in the management of lesions in the head, neck, and uncinate process of the pancreas is yet to be determined. PMID:19845171

Nakeeb, Attila

2009-01-01

332

Laparoscopic Inguinal Hernia Repair  

MedlinePLUS

... inguinal hernia repairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). If may offer a ...

333

Laparoscopic refundoplication in children  

Microsoft Academic Search

Background: Gastroesophageal fundoplication currently is one of the three most common major operations performed on infants and children\\u000a by pediatric surgeons in the United States. With the advent of laparoscopic surgery, the number of gastroesophageal fundoplications\\u000a has virtually exploded. Morbidity always was substantial with this operation, and laparoscopy has not changed this. We describe\\u000a our results with laparoscopic refundoplication in

D. C. van der Zee; N. M. A. Bax; B. M. Ure

2000-01-01

334

Laparoscopic adrenalectomy for cancer.  

PubMed

Laparoscopic procedures are preferred by surgeons and patients alike because of decreased pain, reduced perioperative morbidity, and an earlier return to self-reliance. During the last decade, laparoscopic adrenalectomy has become the technique most commonly used for the removal of benign adrenal tumors. The indications for laparoscopy in malignant adrenal tumors remains controversial, because oncologic resections have not been reproducible compared with open techniques. PMID:23158088

Creamer, Jennifer; Matthews, Brent D

2013-01-01

335

Laparoscopic Total Mesorectum Excision  

PubMed Central

The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum.

Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simoes Neto, J.

2002-01-01

336

Robot-Assisted Laparoscopic Pyeloplasty  

Microsoft Academic Search

\\u000a Laparoscopic pyeloplasty offers the success of open surgery with the benefit of decreased postoperative pain and decreased\\u000a length of stay. Its use, however, is limited by the steep learning curve required for proficient laparoscopic skills. The\\u000a introduction of robotic assistance shortens the laparoscopic learning curve and may allow increased use of laparoscopy in\\u000a performing pediatric laparoscopic pyeloplasty. This chapter describes

Chad R. Tracy; Craig A. Peters

337

Abdominal Cavity and Laparoscopic Surgery  

NSDL National Science Digital Library

For students interested in studying biomechanical engineering, especially in the field of surgery, this lesson serves as an anatomy and physiology primer of the abdominopelvic cavity. Students are introduced to the abdominopelvic cavityâa region of the body that is the focus of laparoscopic surgeryâas well as the benefits and drawbacks of laparoscopic surgery. Understanding the abdominopelvic environment and laparoscopic surgery is critical for biomechanical engineers who design laparoscopic surgical tools.

Integrated Teaching And Learning Program

338

Development of virtual environments for training skills and reducing errors in laparoscopic surgery  

NASA Astrophysics Data System (ADS)

In every surgical procedure there are key steps and skills that, if performed incorrectly, can lead to complications. In conjunction with efforts, based on task and error analysis, in the Videoscopic Training Center at UCSF to identify these key elements in laparoscopic surgical procedures, the authors are developing virtual environments and modeling methods to train the elements. Laparoscopic surgery is particularly demanding of the surgeon's spatial skills, requiring the ability to create 3D mental models and plans while viewing a 2D image. For example, operating a laparoscope with the objective lens angled from the scope axis is a skill that some surgeons have difficulty mastering, even after using the instrument in many procedures. Virtual environments are a promising medium for teaching spatial skills. A kinematically accurate model of an angled laparoscope in an environment of simple targets is being tested in courses for novice and experienced surgeons. Errors in surgery are often due to a misinterpretation of local anatomy compounded with inadequate procedural knowledge. Methods to avoid bile duct injuries in cholecystectomy are being integrated into a deformable environment consisting of the liver, gallbladder, and biliary tree. Novel deformable tissue modeling algorithms based on finite element methods will be used to improve the response of the anatomical models.

Tendick, Frank; Downes, Michael S.; Cavusoglu, Murat C.; Gantert, Walter A.; Way, Lawrence W.

1998-06-01

339

Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret's syndrome  

PubMed Central

Bouveret’s syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations, such as abdominal distension and pain, nausea and vomiting, fever or even gastrointestinal bleeding, which may easily be misdiagnosed. In the present case, a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain, fever, jaundice or melena. At first, gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large, hard stone in the duodenal bulb. A revised diagnosis of Bouveret’s syndrome was made following abdominal computed tomography. Subsequently, the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective, with good patient tolerability, rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret’s syndrome is worth exploring.

Yang, Dong; Wang, Zhen; Duan, Zhi-Jun; Jin, Shi

2013-01-01

340

Laparoscopic Versus Open Appendectomy  

PubMed Central

Summary Background Data: The value of laparoscopy in appendicitis is not established. Studies suffer from multiple limitations. Our aim is to compare the safety and benefits of laparoscopic versus open appendectomy in a prospective randomized double blind study. Methods: Two hundred forty-seven patients were analyzed following either laparoscopic or open appendectomy. A standardized wound dressing was applied blinding both patients and independent data collectors. Surgical technique was standardized among 4 surgeons. The main outcome measures were postoperative complications. Secondary outcome measures included evaluation of pain and activity scores at base line preoperatively and on every postoperative day, as well as resumption of diet and length of stay. Activity scores and quality of life were assessed on short-term follow-up. Results: There was no mortality. The overall complication rate was similar in both groups (18.5% versus 17% in the laparoscopic and open groups respectively), but some early complications in the laparoscopic group required a reoperation. Operating time was significantly longer in the laparoscopic group (80 minutes versus 60 minutes; P = 0.000) while there was no difference in the pain scores and medications, resumption of diet, length of stay, or activity scores. At 2 weeks, there was no difference in the activity or pain scores, but physical health and general scores on the short-form 36 (SF36) quality of life assessment forms were significantly better in the laparoscopic group. Appendectomy for acute or complicated (perforated and gangrenous) appendicitis had similar complication rates, regardless of the technique (P = 0.181). Conclusions: Unlike other minimally invasive procedures, laparoscopic appendectomy did not offer a significant advantage over open appendectomy in all studied parameters except quality of life scores at 2 weeks. It also took longer to perform. The choice of the procedure should be based on surgeon or patient preference.

Katkhouda, Namir; Mason, Rodney J.; Towfigh, Shirin; Gevorgyan, Anna; Essani, Rahila

2005-01-01

341

Single Incision versus Conventional Laparoscopic Cholecystectomy Outcomes: A Meta-Analysis of Randomized Controlled Trials  

PubMed Central

Background Previous meta-analyses that compared the outcome of SILC and CLC have not presented consistent conclusions. This meta-analysis was performed after adding many recent RCTs, to clarify this issue. Methods Relevant articles published in English were identified by searching PubMed, Embase, Web of Knowledge, and the Cochrane Controlled Trial Register from January 1997 to February 2013. Reference lists of the retrieved articles were reviewed to identify additional articles. Primary outcomes (postoperative pain scores, cosmetic score, and length of incision) and secondary outcomes (operating time, blood loss, conversion rates, postoperative complications, postoperative hospital stay, time to initial oral intake, and time to resume work) were pooled. Quantitative variables were calculated using the weighted mean difference (WMD), and qualitative variables were pooled using odds ratios (OR). Results 25 appropriate RCTs were identified from 2128 published articles. 1841 patients were treated, 944 with SILC and 897 with CLC. SILC was superior to CLC in cosmetic score (WMD = 1.155, P<0.001), shorter length of incision (WMD = -3.285, P = 0.029), and postoperative pain within 12 h (VAS in 3-4 h, WMD = -0.704, P = 0.026; VAS in 6-8 h, WMD = -0.613, P = 0.010). CLC was superior to SILC in operating time (OT) (WMD = 13.613, P<0.001) and need of additional instruments (OR = 7.448, P<0.001). Other secondary outcomes were similar. Conclusions SILC offered a better cosmetic result and less postoperative pain for patients with uncomplicated cholelithiasis or polypoid lesions of the gallbladder. However, SILC was associated with a longer OT and required additional instruments.

Geng, Liangyuan; Sun, Changhua; Bai, Jianfeng

2013-01-01

342

Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach  

Microsoft Academic Search

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT

Mauro Neiva Fernandes; Ivan Nazareno Campos Neiva; Francisco de Assis Camacho; Lucas Crociati Meguins; Marcelo Neiva Fernandes; Emília Maíra Crociati Meguins

2008-01-01

343

An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy  

PubMed Central

Objectives Biliary injuries are frequently accompanied by vascular injuries, which may worsen the bile duct injury and cause liver ischemia. We performed an analytical review with the aim of defining vasculobiliary injury and setting out the important issues in this area. Methods A literature search of relevant terms was peformed using OvidSP. Bibliographies of papers were also searched to obtain older literature. Results Vasculobiliary injury was defined as: an injury to both a bile duct and a hepatic artery and/or portal vein; the bile duct injury may be caused by operative trauma, be ischaemic in origin or both, and may or may not be accompanied by various degrees of hepatic ischaemia. Right hepatic artery (RHA) vasculobiliary injury (VBI) is the most common variant. Injury to the RHA likely extends the biliary injury to a higher level than the gross observed mechanical injury. VBI results in slow hepatic infarction in about 10% of patients. Repair of the artery is rarely possible and the overall benefit unclear. Injuries involving the portal vein or common or proper hepatic arteries are much less common, but have more serious effects including rapid infarction of the liver. Conclusions Routine arteriography is recommended in patients with a biliary injury if early repair is contemplated. Consideration should be given to delaying repair of a biliary injury in patients with occlusion of the RHA. Patients with injuries to the portal vein or proper or common hepatic should be emergently referred to tertiary care centers.

Strasberg, Steven M; Helton, W Scott

2011-01-01

344

[Pyeloplasty: pro laparoscopic].  

PubMed

With increasing experience and availability of the da Vinci® robotic surgery system there has been an extension of the indications from initially exclusively ablative interventions, such as nephrectomy and radical prostatectomy to reconstructive interventions, such as pyeloplasty, bladder augmentation and urinary diversion. Laparocopic pyeloplasty has been established for both adults and children, with results comparable to the open procedure. In comparison the conventional laparoscopic procedure is little cost-intensive and therefore widely used. The available literature has to be analysed to find advantages for the cost-intensive, robot-assisted laparoscopic pyeloplasty from which patients can profit. PMID:22526175

Bader, P

2012-05-01

345

Laparoscopic colonic procedures  

Microsoft Academic Search

With the advent and general acceptance of laparoscopy as a means of surgically treating intraabdominal disease processes, procedures on organs other than the gallbladder and female genital tract have slowly evolved. After developing basic techniques in an animal model, a clinical series (n=19) of laparoscopic procedures for a variety of colonic lesions was undertaken and is herein presented. It included

Morris E. Franklin; Raul Ramos; Daniel Rosenthal; William Schuessler

1993-01-01

346

[Laparoscopic appendectomy. Our experience].  

PubMed

The advantages and applications of the videolaparoscopic technique (VL) versus open surgery in the treatment of acute and complicated appendicitis are not well defined. Our study examined 150 patients, 67 males and 83 females. They underwent surgery for acute appendicitis in emergency. The choice between open or laparoscopic tecnique was due to patient's clinical conditions and surgeon's experience. Two of these patients had no infiammatory process. Eleven patients were affected by gynaecological diseases. The last 137 patients underwent surgery for acute appendicitis and the diagnosis was confirmed. Among them, 35 (25%) were affected by a complicated appendicitis with diffuse or clearly defined peritonitis. In 134 patients the surgery was completed laparoscopically. The conversion rate was 2%. Morbility rate was 3%, due to intra abdominal abscesses secondary to acute complicated appendicitis. The mean operative time was 76 min and the mean hospital stay was 4.8 days. The death rate was 0%. In our experience, laparoscopic appendectomy has significant advantages over traditional open surgery in both acute and complicated appendicitis, especially in young women. In this way, we can diagnose pelvic disease that could be characterized by the same symptoms of acute appendicitis, then we suggest laparoscopic appendectomy even just to complete the diagnostic iter. Laparoscopy is useful in terms of convalescence, postoperative pain, hospital stay, aesthetic outcome and an easier exploration of the peritoneal cavity. PMID:22595725

Pezzolla, Angela; Milella, Marialessia; Lattarulo, Serafina; Barile, Graziana; Pascazio, Bianca; Ialongo, Paolo; Fabiano, Gennaro; Palasciano, Nicola

347

Laparoscopic inguinal hernioplasty  

Microsoft Academic Search

Laparoscopic hernioplasty was performed in a prospective fashion in 100 inguinal hernias in 66 patients. When available, a self-expanding prosthesis of Mersilene, strengthened with a cross- or star-shaped wire of Nitinol, was used without fixation (group B, 43 hernias).

Jacques M. Himpens

1993-01-01

348

Telesurgical Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

Introduction: Telepresence surgery offers theoretically to overcome two main problems of laparoscopic surgery, i.e. the limitation to only four degrees of freedom and the lack of stereovision. Since 1998, telesurgical minimally invasive procedures have been performed with the da Vinci system mainly for cardiac bypass surgery. Clinical experience in urology is still very limited. We want to present our initial

Jens Rassweiler; Thomas Frede; Othmar Seemann; Christian Stock; Ludger Sentker

2001-01-01

349

Pediatric Laparoscopic Dismembered Pyeloplasty  

Microsoft Academic Search

We performed laparoscopic dismembered pyeloplasty in a boy with right ureteropelvic junction obstruction using 4 cannula sites, and a dismembering and reanastomosis technique identical to that used in open pyeloplasty. Interrupted sutures were placed and tied intracorporeally. A nephrostomy tube was placed under direct vision for drainage but no ureteral stent was used. Total operating time was 5 hours. The

Craig A. Peters; Richard N. Schlussel; Alan B. Retik

1995-01-01

350

Laparoscopic gastrostomy in children.  

PubMed

During a 30-month period, 28 children aged 6 months-15 years underwent fashioning of a laparoscopic gastrostomy. Indications for operation included: feeding difficulties and failure to thrive in neurologically impaired children (13); chronic renal failure (9); and others (6). There were 17 conventional tube and 11 button gastrostomies. Twelve children had insertion of a gastrostomy alone; the others underwent a concomitant laparoscopic Nissen fundoplication (NFP). The average operation time for gastrostomy alone was 65 min (range 35-104) and for gastrostomy plus NFP 155 min (range 130-246). There were no specific laparoscopic complications. Two patients who required large volumes of eternal drugs and peritoneal dialysis from the 1st post-operative day developed minor external leaks from their stomas. It appears that laparoscopy provides for safe and precise positioning of any standard balloon or button gastrostomy. It is a particularly attractive technique for use in patients already undergoing a laparoscopic fundoplication and those in whom other minimally invasive techniques are contraindicated or fail. PMID:9238116

Humphrey, G M; Najmaldin, A

1997-09-01

351

Laparoscopic surgery in pregnancy  

Microsoft Academic Search

A 32-year-old white lady suffering from tubal infertility was referred to our institution in November 1992 because of low abdominal pain due to a heterotopic pregnancy (one intrauterine sac and the other in the right tube). The patient had undergone, 8 weeks before, her second successful attempt at in vitro fertilization and embryo transfer. We decided to perform a laparoscopic

V. Remorgida; C. Carrer; A. Ferraiolo; M. Natucci; P. Anserini

1995-01-01

352

From the lumen to the laparoscope.  

PubMed

Throughout the ages, the issues that have defined the management of disease processes have been particularly exemplified in the gastrointestinal tract. The use of gas lamps and candles with reflectors by Bozzini, Segalas, Cruise, and Fisher (19th century) allowed for some ingress into both the upper and lower gastrointestinal tract. Von Mikulicz, Leiter, Nitze, Kelling, and Jacobaeus contributed to the development of rigid instruments that could be used endoscopically or laparoscopically. Endoscopic efforts were amplified and extended by Rosenheim, Sternberg, Wolf, and, finally, Schindler, who not only introduced novel lens systems but also for the most part overcame the problems of flexibility and illumination. Bernheim, Ruddock, Veress, and Palmer made significant technical and clinical contributions to abdominal cavity exploration. The subsequent application of Hopkins and Kapany's work on optics, and the development by Hirschowitz and Curtiss of the flexible fiber optic endoscope, enabled the design of instruments that would allow the appropriate illumination and vision of both the farthest reaches of the bowel as well as the interior of the abdomen. Thus, the same endoscopic instruments coupled with a surgical interest in diagnostic laparotomy allowed for the evolution of minimally invasive surgery along a similar timescale. The cycle whereby diagnostic laparotomy in the early part of the century was supplanted by endoscopy and laparoscopy has now attained full circle whereby laparoscopy has evolved from a diagnostic procedure into one with major therapeutic applications and is perceived as the state-of-the-art technique for a wide variety of operations, including appendectomy, cholecystectomy, hernia repair, fundoplication, splenectomy, colectomy, and gastrointestinal anastomoses. PMID:15492154

Modlin, Irvin M; Kidd, Mark; Lye, Kevin D

2004-10-01

353

Is Prophylactic Cholecystectomy Useful in Obese Patients Undergoing Gastric Bypass?  

Microsoft Academic Search

Background: Obesity constitutes a clear risk factor for cholelithiasis, especially if it is associated with a rapid weight\\u000a loss, as is the case of patients following bariatric surgery. Prophylactic cholecystectomy is indicated in biliopancreatic\\u000a diversions due to the high incidence of postoperative cholelithiasis. However, there is no agreement on gastric bypass. This\\u000a study was conducted to establish the incidence of

Héctor Guadalajara; Raquel Sanz Baro; Isabel Pascual; Isabel Blesa; Grevelyn Sosa Rotundo; Jose María Gil López; Ramón Corripio; Gregorio Vesperinas; Luis García Sancho; Jose Antonio Rodríguez Montes

2006-01-01

354

Prophylactic use of cephazolin against wound sepsis after cholecystectomy  

Microsoft Academic Search

A trial of antibiotic prophylaxis with cephazolin against postoperative wound sepsis was carried out on 201 patients undergoing routine cholecystectomy. Wound sepsis occurred in 11 out of 65 controls (16.9%), who were not given the drug; two out of 63 patients (3.2%) given a single dose preoperatively; and four out of 73 patients (5.5%) given the single preoperative dose plus

C J Strachan; J Black; S J Powis; T A Waterworth; R Wise; A R Wilkinson; D W Burdon; M Severn; B Mitra; H Norcott

1977-01-01

355

Cholecystectomy in children with sickle-cell disease  

Microsoft Academic Search

Cholelithiasis is a common complication of sickle-cell disease (SCD); its frequency is variable, ranging from 4% to 55%. Twenty-two children with SCD (Hb SS) underwent cholecystectomy for cholelithiasis. All were managed with a preoperative transfusion regimen to achieve a hemoglobin concentration of 10–12 g\\/dl and a hematocrit of 30%–40%. On the evening before surgery, each patient was hydrated with IV

Ahmed H. Al-Salem; Ramlal Nangalia; Kadappa Kolar; Sayed Qaisaruddin; Ibrahim Al-Dabbous; Ali Al-Jam'a

1995-01-01

356

Efficacy of patient-controlled analgesia in women cholecystectomy patients  

Microsoft Academic Search

The purpose of this comparative study was to examine differences in pain intensity, sleep disturbance, sleep effectiveness, fatigue, and vigor between patients undergoing cholecystectomy who received either patient-controlled analgesia (PCA) or intramuscular (IM) injections of narcotics for postoperative pain. The PCA group consisted of 16 women, aged 22–58; the IM group consisted of 10 women, aged 22–60. Data were collected

Adela Yarcheski

1995-01-01

357

Early experience in human hybrid transgastric and transvaginal endoscopic cholecystectomy  

Microsoft Academic Search

Background  Abdominal procedures have been performed for a long time through the anterior abdominal wall. Since the first reports in the\\u000a 1980s, laparoscopy has become the standard for cholecystectomy, with many advantages over open procedures. Now a natural-orifice\\u000a approach to the peritoneal cavity may further reduce the invasiveness of surgery by either diminishing or avoiding abdominal\\u000a incisions. Several orifice routes to

Gustavo Salinas; Lil Saavedra; Hellen Agurto; Rosa Quispe; Edwin Ramírez; José Grande; Juan Tamayo; Victoria Sánchez; Daniel Málaga; Jeffrey M. Marks

2010-01-01

358

Laparoscopic Management of Large Myomas  

PubMed Central

The objective of this article is to review the different techniques that have been adopted for removal of large myomas laparoscopically. We have also quoted literature about the impact of myomas on Pregnancy and obstetrical outcome and the effect of laparoscopic myomectomy on the same. Technical modifications to remove large myomas have been described along with methods to reduce intraoperative bleeding. This comprehensive review describes all possibilities of laparoscopic myomectomy irrespective of size, site and number.

Sinha, Rakesh; Sundaram, Meenakshi

2009-01-01

359

Virtual reality in laparoscopic surgery.  

PubMed

Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery. PMID:15747974

Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

2004-01-01

360

Laparoscopic radical and partial cystectomy  

PubMed Central

Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy.

Challacombe, Ben J.; Rose, Kristen; Dasgupta, Prokar

2005-01-01

361

The barrier-free trocar technique in three laparoscopic standard procedures  

PubMed Central

BACKGROUND: Numerous technical and surgical innovations took place in laparoscopic surgery in the recent past. It is debatable whether single-access surgery or natural orifice surgery (NOS) will establish for several standard procedures. Most of the NOS-procedures are controversial and single-access surgery still has to prove its equality in controlled trials. In the intention to reduce the ingress incisons and to facilitate instrumentation, we decided to test the barrier-free AirSeal®-trocar in clinical practice. MATERIALS AND METHODS: Laparoscopically we performed a cholecystectomy, gastric wedge-resection and a fundoplication using the barrier-free AirSeal® 12-mm-trocar. This trocar works without any mechanical barrier so that via this trocar the use of two instruments is possible. RESULTS: All three operations were successful. CONCLUSION: Laparoscopic standard procedures are feasible using this barrier-free trocar without a higher degree of difficulty. Because of the facilitated instrumentation, it is possible to work more efficiently and to maintain the focus on the surgical field.

Ruckbeil, Oskar; Lewin, Andreas; Federlein, Matthias; Gellert, Klaus

2012-01-01

362

Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery.  

PubMed

Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently the patient developed one more episode of cardiac arrest but still made a full recovery. The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient. PMID:22862957

Kjeld, Thomas; Hansen, Egon G; Holler, Nana G; Rottensten, Henrik; Hyldegaard, Ole; Jansen, Eric C

2012-08-03

363

Perioperative Management in Children with Sickle Cell Disease Undergoing Laparoscopic Surgery  

PubMed Central

Objective: The aim of this study was to evaluate our experience with laparoscopic surgery in children with sickle cell disease. Methods: A retrospective chart review was performed to analyze the indication for surgery, perioperative management, surgical technique, complications, duration of hospitalization, and outcome. One pediatric surgeon performed all procedures. Results: Thirteen children underwent laparoscopic surgery for the following indications: symptomatic cholelithiasis/cholecystitis in 9; recurrent splenic sequestration in 3; and hypersplenism/symptomatic cholelithiasis in 1. The 7 boys and 6 girls had a median age of 7.8 years. Patients undergoing splenectomy only were younger than those undergoing cholecystectomy (median age, 3.6 years versus 11.5 years, respectively). Four children underwent endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy because of common bile duct dilatation and stones. Twelve patients received packed red blood cell transfusions prior to surgery. The median operative time was 150 minutes, and the median hospitalization was 3 days. Four patients suffered postoperative complications (2 with acute chest syndrome, 1 with recurrent abdominal pain, and 1 with priapism). The patient with abdominal pain was found to have a retained stone in the common bile duct, which was retrieved via endoscopic retrograde cholangiopancreatography and sphincterotomy. All complications resolved with medical management. Conclusions: Laparoscopic surgery is safe in children with sickle cell disease. Meticulous attention to perioperative management, transfusion guidelines, and pulmonary care may decrease the incidence of acute chest syndrome.

Sandoval, Claudio; Ozkaynak, M. Fevzi; Tugal, Oya; Jayabose, Somasundaram

2002-01-01

364

Laparoscopic adrenal cyst resection.  

PubMed

Two patients with left adrenal cysts underwent laparoscopic resection. In one case an adrenal origin of the cyst was suspected. In the other case the cyst was thought to be renal in origin. Both patients were female, ages 16 and 40 years. Operative time was 150 and 160 minutes. Blood loss was 50 and 30 mL. One patient received 14 mg of morphine and 60 mg of ketorolac. The other patient did not require any parenteral analgesics. Hospital stay was 1 day for both patients. Return to normal activity occurred at 15 and 7 days postoperatively, respectively. Histology in both cases revealed benign adrenal cysts. Our experience supports the laparoscopic approach for resection of adrenal cysts. PMID:9892002

Williams, J F; Wolf, J S

1998-12-01

365

Frequent nut consumption and decreased risk of cholecystectomy in women1-3  

Microsoft Academic Search

Background: Gallstone disease is a major source of morbidity in the developed countries. Nuts are rich in several compounds that may protect against gallstone disease. Objective: The association between nut intake and cholecystectomy was examined in a large cohort of women. Design: We prospectively studied nut (peanuts, other nuts, and peanut butter) consumption in relation to the risk of cholecystectomy

Chung-Jyi Tsai; Michael F Leitzmann; Frank B Hu; Walter C Willett; Edward L Giovannucci

366

Laparoscopic radical prostatectomy  

Microsoft Academic Search

The radical prostatectomy has been modified over the years. With the introduction to the modern operating room of robots and\\u000a other tools has come the latest modification: the laparoscopic radical prostatectomy (LRP), first described almost 10 years\\u000a ago. In the past 2 years, the technique of LRP has been made standard, reproducible, and efficient. The LRP virtually eliminates\\u000a the physical

Arnon Krongrad

2000-01-01

367

Robotic laparoscopic fundoplication  

Microsoft Academic Search

Opinion statement  Gastroesophageal reflux disease is a very common disorder, and both medical and surgical treatments have shown outstanding\\u000a results. Whereas proton pump inhibitors are the mainstay of treatment, laparoscopic fundoplication has become a very attractive\\u000a alternative due to its efficacy and low morbidity. There are defined patient categories that may benefit more from laparoscopy\\u000a than medical therapy, but a conclusive

Dimitrios Stefanidis; James R. Korndorffer; Daniel J. Scott

2005-01-01

368

Laparoscopic anatomical hepatic resection  

Microsoft Academic Search

.   Four patients underwent a laparoscopic left hepatic resection for solid tumor, two for metastasis from colonic cancer, and\\u000a two for focal nodular hyperplasia (final diagnosis). The procedure was performed according to the rules of conventional hepatic\\u000a surgery and cancer surgery. No blood transfusion was necessary. No surgical complication occurred. In malignant disease, laparoscopy\\u000a allows a good staging and the

G. Samama; L. Chiche; J. L. Bréfort; Y. Le Roux

1998-01-01

369

Total Laparoscopic Pancreaticoduodenectomy  

PubMed Central

Introduction: Total laparoscopic pancreaticoduodenectomy (TLPD) remains one of the most advanced laparoscopic procedures. Owing to the evolution in laparoscopic technology and instrumentation within the past decade, laparoscopic pancreaticoduodenectomy is beginning to gain wider acceptance. Methods: Data were collected for all patients who underwent a TLPD at our institution. Preoperative evaluation consisted of computed tomography scan with pancreatic protocol and selective use of magnetic resonance imaging and/or endoscopic ultrasonography. The TLPD was done with 6 ports on 3 patients and 5 ports in 2 patients and included a celiac, periportal, peripancreatic, and periduodenal lymphadenectomy. Pancreatic stents were used in all 5 cases, and intestinal continuity was re-established by intracorporeal anastomoses. Results: Five patients underwent a TLPD for suspicion of a periampullary tumor. There were 3 women and 2 men with a mean age of 60 years and a mean body mass index of 32.8. Intraoperatively, the mean operative time was 9 hours 48 minutes, with a mean blood loss of 136 mL. Postoperatively, there were no complications and a mean length of stay of 6.6 days. There was no lymph node involvement in 4 out of 5 specimens. The pathological results included intraductal papillary mucinous neoplasm in 2 patients, pancreatic adenocarcinoma in 1 patient (R0 resection), benign 4-cm periampullary adenoma in 1 patient, and a somatostatin neuroendocrine carcinoma in 1 patient (R0, N1). Conclusion: TLPD is a viable alternative to the standard Whipple procedure. Our early experience suggests decreased length of stay, quicker recovery, and improved quality of life. Complication rates appear to be improved or equivalent.

Kamyab, Armin

2013-01-01

370

Laparoscopic adrenal surgery  

Microsoft Academic Search

Summary.   Minimally invasive adrenalectomy is now an accepted alternative to conventional adrenalectomy. As in open surgery, several\\u000a different endoscopic approaches to the adrenal glands have been described. In principle, one must distinguish between the\\u000a laparoscopic and the retroperitoneoscopic access. All adrenal tumors – pheochromocytomas included – except adrenal carcinomas\\u000a can be removed endoscopically. However, the use of these techniques is

C. Nies; E. Möbius; M. Rothmund

1997-01-01

371

[Experimental laparoscopic renal autograft].  

PubMed

Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased. The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vascular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed. PMID:15046477

Aguilera Bazán, A; Murillo, S; Benito de la Víbora, J; Cisneros Ledo, J; de la Peña Barthel, J

2004-01-01

372

Laparoscopic bariatric surgery  

Microsoft Academic Search

Laparoscopy has meant profound changes for the field of bariatric surgery. Bariatric operations, which are technically difficult\\u000a because of the patient population, were not performed laparoscopically until the last 5 years of the 20th century. The years\\u000a 1998 to 2003, herein defined as the Bariatric Revolution, saw profound changes in the way bariartric surgery was practiced.\\u000a Major changes in patient

B. Schirmer; Stephen H. Watts

2006-01-01

373

Causes and Prevention of Laparoscopic Bile Duct Injuries  

PubMed Central

Objective To apply human performance concepts in an attempt to understand the causes of and prevent laparoscopic bile duct injury. Summary Background Data Powerful conceptual advances have been made in understanding the nature and limits of human performance. Applying these findings in high-risk activities, such as commercial aviation, has allowed the work environment to be restructured to substantially reduce human error. Methods The authors analyzed 252 laparoscopic bile duct injuries according to the principles of the cognitive science of visual perception, judgment, and human error. The injury distribution was class I, 7%; class II, 22%; class III, 61%; and class IV, 10%. The data included operative radiographs, clinical records, and 22 videotapes of original operations. Results The primary cause of error in 97% of cases was a visual perceptual illusion. Faults in technical skill were present in only 3% of injuries. Knowledge and judgment errors were contributory but not primary. Sixty-four injuries (25%) were recognized at the index operation; the surgeon identified the problem early enough to limit the injury in only 15 (6%). In class III injuries the common duct, erroneously believed to be the cystic duct, was deliberately cut. This stemmed from an illusion of object form due to a specific uncommon configuration of the structures and the heuristic nature (unconscious assumptions) of human visual perception. The videotapes showed the persuasiveness of the illusion, and many operative reports described the operation as routine. Class II injuries resulted from a dissection too close to the common hepatic duct. Fundamentally an illusion, it was contributed to in some instances by working too deep in the triangle of Calot. Conclusions These data show that errors leading to laparoscopic bile duct injuries stem principally from misperception, not errors of skill, knowledge, or judgment. The misperception was so compelling that in most cases the surgeon did not recognize a problem. Even when irregularities were identified, corrective feedback did not occur, which is characteristic of human thinking under firmly held assumptions. These findings illustrate the complexity of human error in surgery while simultaneously providing insights. They demonstrate that automatically attributing technical complications to behavioral factors that rely on the assumption of control is likely to be wrong. Finally, this study shows that there are only a few points within laparoscopic cholecystectomy where the complication-causing errors occur, which suggests that focused training to heighten vigilance might be able to decrease the incidence of bile duct injury.

Way, Lawrence W.; Stewart, Lygia; Gantert, Walter; Liu, Kingsway; Lee, Crystine M.; Whang, Karen; Hunter, John G.

2003-01-01

374

Complications of laparoscopic colorectal surgery  

Microsoft Academic Search

PURPOSE: The aim of this study was to test if the techniques learned during our early learning experience have proved to be effective in reducing the complications specifically related to the laparoscopic technique of colorectal surgery. METHODS: From October 1991 until July 1996, 195 laparoscopic operations were performed on the colon and the rectum. These data were divided into “early”

Sergio W. Larach; Sanjiv K. Patankar; Andrea Ferrara; Paul R. Williamson; Santiago E. Perozo; Alan S. Lord

1997-01-01

375

Choice of Laparoscopic Exposure Method  

Microsoft Academic Search

Presently, with few exceptions, carbon dioxide is the gas used for laparoscopic procedures in humans. CO2 is colorless, noncombustible, odorless, and inexpensive, and, because of its high solubility, is the least dangerous gas should a gas embolism occur during a laparoscopic procedure. Interestingly, several of the major drawbacks associated with the use of CO2 gas, namely, hypercarbia, acidosis, and other

Christopher A. Jacobi; C. Braumann

376

Telerobotics in laparoscopic general surgery  

Microsoft Academic Search

Summary  BACKGROUND: Telerobotic systems are considered to further improve laparoscopic surgery. They may have some advantages over conventional laparoscopic instruments such as increase in the degree of freedom and 3-D vision. On the other hand, loss of tactile sensitivity and enormous costs are limiting features of these devices. Currently, 2 systems are in use, the Da Vinciand the Zeussystem. METHODS: Our

C. Wullstein; M. Golling; W. O. Bechstein

2004-01-01

377

Laparoscopic surgery complications: Postoperative peritonitis  

PubMed Central

Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery.

Draghici, L; Draghici, I; Ungureanu, A; Copaescu, C; Popescu, M; Dragomirescu, C

2012-01-01

378

Laparoscopic radical prostatectomy: preliminary results  

Microsoft Academic Search

Objectives. To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures.Methods. Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first

C. C Abbou; L Salomon; A Hoznek; P Antiphon; A Cicco; F Saint; W Alame; J Bellot; D. K Chopin

2000-01-01

379

Laparoscopic Repair of Ureteral Transection  

Microsoft Academic Search

Injury to the ureter is a possible complication of laparoscopic surgery. Traditionally, it is repaired by laparotomy. During laparoscopic surgery for bilateral ovarian remnants in a 29-year-old woman, the left ureter was transected. The ureter was repaired by primary end-to-end anastomosis by laparoscopy. The patient recovered uneventfully, and postoperative intravenous puelogram confirmed the repair to be intact.

Paul K. Tulikangas; Jeffrey M. Goldberg; Inderbir S. Gill

2000-01-01

380

Laparoscopic Excision of an Infected \\  

Microsoft Academic Search

Primary retroperitoneal pseudocysts are rare entities. Though laparoscopic approach has been described in their treatment, open surgical excision is still the mainstay of treatment for these lesions. We present a case of infected retroperitoneal pseudocyst and its successful laparoscopic excision. The patient was an 80-year old female. Contrast enhanced CT scan of the abdomen and ultrasonography confirmed a large retroperitoneal

Chinnusamy Palanivelu; Muthukumaran Rangarajan; Rangaswamy Senthilkumar; Madhupalayam Velusamy Madhankumar; Shankar Annapoorni

381

[Open and laparoscopic adrenalectomy. 10 years review].  

PubMed

We present a 10 years open adrenalectomy review in our Service and the beginning of laparoscopic adrenalectomy in the last year as a part of the retroperitoneal laparoscopic program at the Hospital Universitario La Paz . The first laparoscopic adrenalectomy was done after 21 retroperitoneal laparoscopic surgeries. Our initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases. PMID:17253071

Aguilera Bazán, A; Pérez Utrilla, M; Alonso y Gregorio, S; Cansino Alcaide, R; Cisneros Ledo, J; De la Peña Barthel, J

382

Gossypiboma presented as abdominal lump seven years after open cholecystectomy  

PubMed Central

Gossypiboma is very rare in clinical practice. Despite its clinical importance, it carries some medico legal implications. We report a case of gossypiboma in a 54 years old female who presented with pain and a slowly growing lump in the abdomen 7 years after open cholecystectomy. Computed tomography (CT) scan of the abdomen showed a mass with enhanced internal septae and a radio-opaque marker within it, raising the suspicion of a foreign body. She underwent excision of the mass along with a segment of densely adherent transverse colon. Post-operative recovery was uneventful and the patient was well at 19-month follow up.

Ray, S; Das, K

2011-01-01

383

Laparoscopic Total Mesorectal Excision  

PubMed Central

Objective To analyze total mesorectal excision (TME) for rectal cancer by the laparoscopic approach during a prospective nonrandomized trial. Summary Background Data Improved local control and survival rates in the treatment of rectal cancer have been reported after TME. Methods The authors conducted a prospective consecutive series of 100 laparoscopic TMEs for low and mid-rectal tumors. All patients had a sphincter-saving procedure. Case selection, surgical technique, and clinical and oncologic results were reviewed. Results The distal limit of rectal neoplasm was on average 6.1 (range 3–12) cm from the anal verge. The mean operative time was 250 (range 110–540) minutes. The conversion rate was 12%. Excluding the patient who stayed 104 days after a severe fistula and reoperation, the mean postoperative stay was 12.05 (range 5–53) days. The 30-day mortality was 2% and the overall postoperative morbidity was 36%, including 17 anastomotic leaks. Of 87 malignant cases, 70 (80.4%) had a minimum follow-up of 12 months, with a median follow-up of 45.7 (range 12–72) months. During this period 18.5% (13/70) died of cancer and 8.5% (6/70) are alive with metastatic disease. The port-site metastasis rate was 1.4% (1/70): a rectal cancer stage IV presented with a parietal recurrence at 17 months after surgery. The locoregional pelvic recurrence rate was 4.2% (3/70): three rectal cancers stage III at 19, 13, and 7 postoperative months. Conclusions Laparoscopic TME is a feasible but technically demanding procedure (12% conversion rate). This series confirms the safety of the procedure, while oncologic results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.

Morino, Mario; Parini, Umberto; Giraudo, Giuseppe; Salval, Micky; Brachet Contul, Riccardo; Garrone, Corrado

2003-01-01

384

Laparoscopic colorectal resection for diverticulitis.  

PubMed

This study evaluated outcome in patients undergoing laparoscopically assisted sigmoid resection for diverticular disease. A total of 29 consecutive patients were treated surgically for colonic diverticulitis; in 27 of these laparoscopy was performed. The review of medical records from a control group of 34 patients undergoing open resection were used for comparison. The conversion rate was 7.5%. Using the laparoscopic technique the duration of surgery was longer (165 vs. 121 min, P < 0.05), blood loss less (182 vs. 352 ml, P < 0.05), and subsequent blood transfusion less (0 vs. 61%). The incidence of complications following laparoscopic resection was lower (two anastomotic leakages, two wound infections) than in the conventional group. Convalescence in the laparoscopic group was more rapid and hospital stay shorter (7.9 vs. 14.3 days, P < 0.05). In the laparoscopic group patients expressed less pain at rest and in motion. The cost of the laparoscopically assisted procedure was less than that of conventional resection (7185 vs. 8975 DM). In this series laparoscopically assisted sigmoid resection for diverticulitis proved safe. Recovery was faster, hospital stay was shorter, and patients expressed less pain than in conventional open surgery. PMID:9548100

Köhler, L; Rixen, D; Troidl, H

1998-01-01

385

Laparoscopic tailored Nissen fundoplication  

Microsoft Academic Search

Background  It is difficult sometimes to determine the suture points for proper Nissen fundoplication under laparoscopy. We introduce\\u000a a new procedure to define the suture points in Laparoscopic Nissen fundoplication (LNF).\\u000a \\u000a \\u000a \\u000a \\u000a Surgical technique  After dissection of the hiatus and mobilization of the fundus, the circumference of the esophagus c is measured at a point 2-cm cranial from the esophagogastric junction over the

Shinya Asami; Takashi Ishikawa; Shinichiro Kubo; Takayuki Iwamoto; Shinichiro Watanabe; Hitoshi Kin

2010-01-01

386

Laparoscopic partial splenectomy  

Microsoft Academic Search

Background  The immunologic function of the spleen and its important role in immune defense has led to splenic-preserving surgery. This\\u000a study aimed to evaluate whether laparoscopic partial splenectomy is safe.\\u000a \\u000a \\u000a \\u000a Methods  Data on consecutive patients presenting with localized benign or malignant disease of the spleen were included in a prospective\\u000a database. The surgical technique consisted of six steps: patient positioning and trocar

S. Uranues; D. Grossman; L. Ludwig; R. Bergamaschi

2007-01-01

387

Laparoscopic splenectomy for ITP  

Microsoft Academic Search

Background: A comparison of safety, efficacy, and cost of laparoscopic splenectomy (LS) vs open splenectomy (OS) for idiopathic thrombocytopenic\\u000a purpura (ITP) was performed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: The records of 49 consecutive patients who underwent splenectomy for ITP (31 LS and 18 OS) at a large metropolitan teaching\\u000a hospital between 3\\/91 and 8\\/95 were reviewed. Morbidity, mortality, hospital stay, operative time, blood loss,

R. L. Friedman; M. J. Fallas; B. J. Carroll; J. R. Hiatt; E. H. Phillips

1996-01-01

388

Laparoscopic vessel sealing technologies.  

PubMed

Laparoscopic vessel sealing devices have revolutionized modern laparoscopy. These devices fall into 2 major categories: advanced bipolar and ultrasonic instruments. The range of tissue effects available with these technologies is more limited than with conventional monopolar electrosurgery; however, both advanced bipolar and ultrasonic devices efficiently seal vessels (?7-mm and ?5-mm diameter, respectively), and most also have built-in tissue transection capabilities. These technologies have been the subject of a range of comparative studies on their relative advantages and disadvantages, and, to date, neither advanced bipolar or ultrasonic devices has been proven to be superior. PMID:23659750

Lyons, Stephen D; Law, Kenneth S K

389

Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy.  

PubMed Central

OBJECTIVE: This endoscopic retrograde cholangiopancreatography-(ERCP)based study estimates the potential role of laparoscopic cholecystojejunostomy for palliation of patients with malignant obstructive jaundice. SUMMARY BACKGROUND DATA: Traditional treatment of malignant obstructive jaundice has used a standard bilioenteric anastomosis. Laparoscopic biliary bypass via a gallbladder conduit currently is an established technique; it provides a low initial morbidity alternative to open procedures, similar to endoscopic stenting. No study has specifically addressed anatomic factors relevant to cholecystojejunostomy, such as prior cholecystectomy, stricture location in reference to the hepatocystic junction, and cystic duct patency in patients with malignant obstructive jaundice. METHODS: Retrograde cholangiograms were reviewed from consecutive patients with malignant obstructive jaundice and a control group without biliary disease who underwent ERCP during a 2-year period. Patients with either prior biliary surgery or hilar tumors were excluded. The presence of gallbladder or cystic duct filling was assessed. In patients with patent cystic ducts, the distance from obstruction to the cystic duct takeoff was classified as either greater or less than 1 cm. RESULTS: Nearly half the patients with malignant obstructive jaundice were ineligible for cholecystojejunostomies because of prior biliary surgery (29%) or hilar tumors (17%). Half (50 of 101) of the remaining potential candidates had patent hepatocystic junctions. Patients with ampullary carcinoma and patent hepatocystic junctions (5 of 9) were all ideal candidates for cholecystojejunostomies, having biliary obstruction more than 1 cm from the cystic duct takeoff. Two thirds of the remaining eligible patients (28 of 45) had obstructions less than 1 cm from patent hepatocystic junctions. CONCLUSIONS: Palliation of malignant obstructive jaundice by laparoscopic cholecystojejunostomy should only be attempted after direct cholangiography demonstrates a patent hepatocystic junction that is well separated from the malignant stricture. The majority of patients with malignant obstructive jaundice are ineligible for cholecystojejunostomies because of prior cholecystectomies, hilar obstructions, or tumor involvement of the hepatocystic junction. Nonoperative treatments will continue to be indicated for the majority of patients with malignant obstructive jaundice. Images Figure 2. Figure 3.

Tarnasky, P R; England, R E; Lail, L M; Pappas, T N; Cotton, P B

1995-01-01

390

Transvaginal laparoscopic donor nephrectomy.  

PubMed

Laparoscopic donor nephrectomy (LDN) has numerous advantages over open donor nephrectomy. The cosmetic issues and pain that arise due to the 5 to 6-cm incisions on the abdominal wall in LDN have led to transvaginal laparoscopic donor nephrectomy (TVLDN). Between May and August 2012, we performed seven donor nephrectomies via a transvaginal approach. The mean age of the donors was 53.0 ± 9.52 years. The mean operative time was 97.29 ± 39.47 minutes and mean warm ischemia time, 220.71 ± 55.49 seconds. Donors were mobilized, began oral intake at 8 hours postoperative, and were all discharged within the first 24 hours. Except one dose of analgesic applied immediately after the operation, no additional medication was required. No infectious complications were encountered in any recipient. TVLDN may be a good alternative for female donors. Compared with LDN, TVLDN has benefits of less postoperative pain, faster recovery, shorter hospital stay, and excellent cosmetic results. PMID:23622577

Ero?lu, A; ?ener, C; Tabandeh, B; Tilif, S; Okçuo?lu Kad?o?lu, Z; Kaçar, S

2013-04-01

391

LAPAROSCOPIC HEMINEPHROURETERECTOMY IN PEDIATRIC PATIENTS  

Microsoft Academic Search

PurposeAn increasing number of operative procedures in pediatric urology can be performed by laparoscopy. We report our experience with laparoscopic heminephroureterectomy, which is a typical operation in pediatric patients.

Gunter Janetschek; Jorg Seibold; Christian Radmayr; Georg Bartsch

1997-01-01

392

Laparoscopic colorectal resection for diverticulitis  

Microsoft Academic Search

This study evaluated outcome in patients undergoing laparoscopically assisted sigmoid resection for diverticular disease.\\u000a A total of 29 consecutive patients were treated surgically for colonic diverticulitis; in 27 of these laparoscopy was performed.\\u000a The review of medical records from a control group of 34 patients undergoing open resection were used for comparison. The\\u000a conversion rate was 7.5%. Using the laparoscopic

L. Köhler; D. Rixen; H. Troidl

1998-01-01

393

Robotic-Assisted Laparoscopic Pyeloplasty  

Microsoft Academic Search

Robotic-assisted laparoscopic pyeloplasty (RALP) is an elegant, minimally invasive reconstructive procedure to treat UPJ obstruction.\\u000a The technique is discussed here in detail. Some selected patients can be discharged within 18 hours. Some series over five\\u000a years report success rates of between 95 and 100%. The benefits over laparoscopic pyeloplasty are arguable and need to carefully\\u000a be measured against the increased

Declan G. Murphy; Jamie Kearsley; Anthony J. Costello

394

Rhabdomyolysis after Laparoscopic Bariatric Surgery  

Microsoft Academic Search

Background: Postoperative rhabdomyolysis is an uncommon event. The aim of this study was to determine the incidence of rhabdomyolysis\\u000a following laparoscopic obesity surgery. Methods: Rhabdomyolysis was studied prospectively. Over a 6-month period, 66 consecutive\\u000a patients underwent bariatric surgery (gastric banding (n=50) and gastric bypass (n=16)). All patients underwent laparoscopic\\u000a procedures. A range of blood tests, including serum creatine phosphokinase (CPK)

Philippe Mognol; Stéphane Vignes; Denis Chosidow; Jean-Pierre Marmuse

2004-01-01

395

Laparoscopic-assisted colon resection  

Microsoft Academic Search

The popularity and success of laparoscopic biliary tract surgery have persuaded surgeons to explore other applications for\\u000a rigid endoscopic surgery. From July 1990 to February 1993 a total of 65 patients (mean age 57 years; range 41–82) underwent\\u000a attempted laparoscopic colon resection. Indications for surgical intervention included cancer (39), adenomatous polyps (14),\\u000a diverticulosis (10), stricture (1), and foreign-body perforation (1).

K. A. Zucker; D. E. Pitcher; D. T. Martin; R. S. Ford

1994-01-01

396

Laparoscopic Lymphadenectomy for Gynecologic Malignancies  

Microsoft Academic Search

Objective. The purpose of our study was to detail our 5-year experience with laparoscopic lymphadenectomy for gynecologic malignancies.Methods. From 11\\/5\\/92 to 3\\/9\\/98, we performed laparoscopic lymphadenectomies on 94 patients with various gynecologic malignancies. Pelvic, paraaortic, and combinations of both pelvic and paraaortic lymphadenectomies were performed depending on the primary site of disease and indication for lymph node dissection. Data were

Peter R. Dottino; Daniel H. Tobias; AnnMarie Beddoe; Anne L. Golden; Carmel J. Cohen

1999-01-01

397

Outpatient laparoscopic sterilization.  

PubMed

This is a report on a pilot study conducted in Malaysia of outpatient sterilization utilizing laparoscopic technique under local anesthesia and sedation. The preliminary report based on 305 patients is presented with emphasis on the advantages and possible weaknesses of such procedure. Sterilization is performed in the Family Planning Specialist Center, Maternity Hospital. Patients are motivated towards sterilization during the immediate postpartum period in the Maternity Hospital and are counseled regarding the actual procedure. The mean age of the 305 patients was 32.08 years; the mean gravidity was 4.92; and the mean parity was 4.57. The majority of the patients came from the lower social strata with low educational attainment and low income. 253 cases of sterilizations were performed by laparoscopic procedures and 43 cases by minilaparotomy. In 9 cases difficulty was encountered with laparoscopy and subsequently the minilaparotomy was used. The majority of cases seemed to tolerate the sedation and local anesthesia fairly well and without much complaint of pain. Only a very small number of patients complained of pain particularly at the time when the Fallope or Lay rings were applied to the fallopian tubes. The overall complication rate was 14 (4.9%) and of these mild wound sepsis accounted for 6 (1.96%). Most of the wound sepsis was very mild and healed very quickly on daily dressing. No cases of pelvic sepsis were reported. There were 3 cases of uterine perforation by the uterine elevator. There were 2 cases where the fallopian tubes were traumatized and some degree of bleeding occurred. The bleeding was easily controlled by applying another Fallope ring. 2 patients had vomiting during the laparoscopic procedure. There were 7 cases of failed sterilization. 6 of the cases were performed by a trainee registrar in obstetrics and gynecology. The last was performed by a specialist gynecologist. Most of the failures were due to wrong application of rings. The cost per patient was estimated to be around 20 ringgit for a pair of tubal rings, anesthetic agents and suture materials. This preliminary study showed that female sterilization could be done easily as an outpatient procedure. PMID:6459518

Hamid Arshat; Yuliawiratman

1981-03-01

398

Lessons Learned from Laparoscopic Gastric Banding.  

PubMed

The author reviews 27 laparoscopic gastric banding operations, of which 19 cases were completed. Of the 27 operations, eight were revisions of earlier laparoscopic banding. The lessons learned from these cases are highlighted. PMID:10757955

Broadbent

1993-11-01

399

Laparoscopic partial splenic resection.  

PubMed

Twenty domestic pigs with an average weight of 30 kg were subjected to laparoscopic partial splenic resection with the aim of determining the feasibility, reliability, and safety of this procedure. Unlike the human spleen, the pig spleen is perpendicular to the body's long axis, and it is long and slender. The parenchyma was severed through the middle third, where the organ is thickest. An 18-mm trocar with a 60-mm Endopath linear cutter was used for the resection. The tissue was removed with a 33-mm trocar. The operation was successfully concluded in all animals. No capsule tears occurred as a result of applying the stapler. Optimal hemostasis was achieved on the resected edges in all animals. Although these findings cannot be extended to human surgery without reservations, we suggest that diagnostic partial resection and minor cyst resections are ideal initial indications for this minimally invasive approach. PMID:7773460

Uranüs, S; Pfeifer, J; Schauer, C; Kronberger, L; Rabl, H; Ranftl, G; Hauser, H; Bahadori, K

1995-04-01

400

Is cholecystectomy really an indication for concomitant splenectomy in mild hereditary spherocytosis?  

Microsoft Academic Search

Background\\/aimThe British Committee for Standards in Haematology currently recommends concomitant splenectomy in children with mild hereditary spherocytosis (HS) undergoing cholecystectomy for symptomatic gallstones. However, splenectomy is associated with a risk of life-threatening infection, particularly in young children. The aim of this study was to audit the outcome of the practice of uncoupling splenectomy and cholecystectomy in such patients.MethodsChildren referred with

Naved K Alizai; E Michael Richards; Mark D Stringer

2010-01-01

401

Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity  

PubMed Central

Background Controversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity. Methods A decision model was developed to evaluate the cost-effectiveness of current strategies: routine concurrent cholecystectomy, Roux-en-Y gastric bypass alone with or without postoperative ursodiol therapy, and selective cholecystectomy based on preoperative findings on ultrasonography. Probabilities were obtained from a comprehensive literature review. Costs and hospital days were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. One-way sensitivity analyses were performed. Results The least expensive strategy was to perform RYGB alone without preoperative ultrasonography, with an average cost (over RYGB costs) of $537 per patient. RYGB with concurrent cholecystectomy had a cost of $631. Selective cholecystectomy based on preoperative ultrasonography was dominated by the other 2 strategies. Our model was most sensitive to the probability of developing gallbladder-related symptoms after RYGB alone. When the incidence of gallbladder-related symptoms was <4.6%, the dominant strategy was to perform a RYGB alone without preoperative ultrasonography. For values >6.9%, performing concurrent cholecystectomy at the time of the RYGB was superior to other strategies. When ursodiol was used, the least expensive strategy was to perform a concurrent cholecystectomy during RYGB. Conclusion The main factor determining the most cost-effective strategy is the incidence of gallbladder-related symptoms after RYGB. The use of ursodiol was associated with an increase in cost that does not justify its use after RYGB. Finally, selective cholecystectomy based on preoperative ultrasonography was dominated by the other strategies in the scenarios evaluated.

Benarroch-Gampel, Jaime; Lairson, David R.; Boyd, Casey A.; Sheffield, Kristin M.; Ho, Vivian; Riall, Taylor S.

2012-01-01

402

Optimal teaching environment for laparoscopic ventral herniorrhaphy  

Microsoft Academic Search

.   The introduction of laparoscopic techniques after residency training has created a new paradigm dependent on laparoscopic\\u000a workshops. This study tested the benefit of an animate course and evaluated the role of proctoring in learning to perform\\u000a laparoscopic ventral hernia repair (LVHR). Surgeons who had taken a 1-day LVHR course (n=59) were polled to determine previous experience with laparoscopic procedures

B. T. Heniford; B. D. Matthews; E. Box; C. Backus; K. Kercher; F. Greene; R. Sing

2002-01-01

403

Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones  

PubMed Central

Background The present study is a meta-analysis of English articles comparing one-stage [laparoscopic common bile duct exploration or intra-operative endoscopic retrograde cholangiopancreatography (ERCP)] vs. two-stage (laparoscopic cholecystectomy preceded or followed by ERCP) management of common bile duct stones. Methods MEDLINE/PubMed and Science Citation Index databases (1990–2011) were searched for randomized, controlled trials that met the inclusion criteria for data extraction. Outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.1. Results Nine trials with 933 patients were studied. No significant differences was observed between the two groups with regard to bile duct clearance (OR, 0.89; 95% CI, 0.65–1.21), mortality (OR, 1.2; 95% CI, 0.32–4.52), total morbidity (OR, 0.75; 95% CI, 0.53–1.06), major morbidity (OR, 0.95; 95% CI, 0.60–1.52) and the need for additional procedures (OR, 1.58; 95% CI, 0.76–3.30). Conclusions Outcomes after one-stage laparoscopic/endoscopic management of bile duct stones are no different to the outcomes after two-stage management.

Alexakis, Nicholas; Connor, Saxon

2012-01-01

404

Transgastric cholecystectomy: From the laboratory to clinical implementation  

PubMed Central

After the first report by Kalloo et al on transgastric peritoneoscopy in pigs, it rapidly became apparent that there was no room for an under-evaluated concept and blind adoption of an appealing (r)evolution in minimal access surgery. Systematic experimental work became mandatory before any translation to the clinical setting. Choice and management of the access site, techniques of dissection, exposure, retraction and tissue approximation-sealing were the basics that needed to be evaluated before considering any surgical procedure or study of the relevance of natural orifice transluminal endoscopic surgery (NOTES). After several years of testing in experimental labs, the revolutionary concept of NOTES, is now progressively being experimented on in clinical settings. In this paper the authors analyse the challenges, limitations and solutions to assess how to move from the lab to clinical implementation of transgastric endoscopic cholecystectomy.

Dallemagne, Bernard; Perretta, Silvana; Allemann, Pierre; Donatelli, Gianfranco; Asakuma, Mitsuhiro; Mutter, Didier; Marescaux, Jacques

2010-01-01

405

Transgastric cholecystectomy: From the laboratory to clinical implementation.  

PubMed

After the first report by Kalloo et al on transgastric peritoneoscopy in pigs, it rapidly became apparent that there was no room for an under-evaluated concept and blind adoption of an appealing (r)evolution in minimal access surgery. Systematic experimental work became mandatory before any translation to the clinical setting. Choice and management of the access site, techniques of dissection, exposure, retraction and tissue approximation-sealing were the basics that needed to be evaluated before considering any surgical procedure or study of the relevance of natural orifice transluminal endoscopic surgery (NOTES). After several years of testing in experimental labs, the revolutionary concept of NOTES, is now progressively being experimented on in clinical settings. In this paper the authors analyse the challenges, limitations and solutions to assess how to move from the lab to clinical implementation of transgastric endoscopic cholecystectomy. PMID:21160872

Dallemagne, Bernard; Perretta, Silvana; Allemann, Pierre; Donatelli, Gianfranco; Asakuma, Mitsuhiro; Mutter, Didier; Marescaux, Jacques

2010-06-27

406

Laparoscopic subtotal splenectomy in hereditary spherocytosis  

Microsoft Academic Search

The paper by Sanjeev Dutta et al. [1] about the laparoscopic approach to partial splenectomy in children with hereditary spherocytosis states that they have developed a novel laparoscopic partial splenectomy technique that combines the benefits of partial splenectomy with those of a laparoscopic approach. This technique, however, is not new, as erroneously stated by the authors. The technique was first

C. Vasilescu; O. Stanciulea; C. Arion

2007-01-01

407

Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma  

Microsoft Academic Search

Laparoscopic radical nephrectomy has been developed and applied for patients with renal cell carcinoma since 1992. The number of patients undergoing laparoscopic radical nephrectomy has explosively increased worldwide in the recent years, and laparoscopy is extended to patients with advanced disease. It is very important to clarify the present status of laparoscopic radical nephrectomy among the treatment modalities for patients

Yoshinari Ono; Ryohei Hattori; Momokazu Gotoh; Tsuneo Kinukawa; Shin Yamada; Osamu Kamihira

408

Failure to Perform Cholecystectomy for Acute Cholecystitis in Elderly Patients is Associated with Increased Morbidity, Mortality, and Cost  

PubMed Central

Background Cholecystectomy during initial hospitalization is the current recommended therapy for acute cholecystitis. The rate of cholecystectomy and subsequent healthcare trajectory in elderly patients with acute cholecystitis has not been evaluated. Study Design We used 5% national Medicare sample claims data from 1996–2005 to identify a cohort of patients ?66 requiring urgent/emergent admission for acute cholecystitis. We evaluated cholecystectomy rates on initial hospitalization, the factors independently predicting receipt of cholecystectomy, the factors predicting further gallstone-related complications, and 2-year survival in the cholecystectomy and no cholecystectomy group in univariate and multivariate models. Results 29,818 Medicare beneficiaries were urgently/emergently admitted for acute cholecystitis from 1996–2005. The mean age was 77.7±7.3 years. 89% of patients were white and 58% were female. 25% of patients did not undergo cholecystectomy during the index admission. Lack of definitive therapy was associated with a 27% subsequent cholecystectomy rate and a 38% gallstone-related readmission rate over in the two years after discharge, while the readmission rate was only 4% in patients undergoing cholecystectomy (P<0.0001). No cholecystectomy on initial hospitalization was associated with worse 2-year survival (HR = 1.56, 95% CI 1.47 – 1.65) even after controlling for patient demographics and comorbidities. Readmissions lead to an additional $7,000 in Medicare payments per readmission. Conclusions Our study demonstrates that 25% of Medicare beneficiaries cholecystectomy was not performed on index admission, leading to readmissions in 38% of surviving patients. For patients requiring readmission, the number of open procedures was increased, and the additional Medicare payments were $7,000 per admission. Cholecystectomy for acute cholecystitis in elderly patients should be performed during initial hospitalization to prevent recurrent episodes of cholecystitis, multiple readmissions, higher readmission rates, and increased costs.

Riall, Taylor S; Zhang, Dong; Townsend, Courtney M; Kuo, Yong-Fang; Goodwin, James S

2010-01-01

409

The umbilicus in laparoscopic surgery  

Microsoft Academic Search

Background  This study examines the factors related to infection and incisional herniation after laparoscopy at the umbilicus, as compared\\u000a with those at remote sites.\\u000a \\u000a \\u000a \\u000a Methods  From a prospective database of 561 cholecystectomies, 190 inguinal hernia repairs, 71 Nissen fundoplications, and 51 ventral\\u000a hernia repairs, 873 consecutive Hasson cannula sites, 748 umbilicus sites, and 125 remote sites were analyzed.\\u000a \\u000a \\u000a \\u000a Results  The wound infection rate

A. J. Voitk; S. G. S. Tsao

2001-01-01

410

An Evaluation of the Feasibility, Validity, and Reliability of Laparoscopic Skills Assessment in the Operating Room  

PubMed Central

Objective: To assess the use of a synchronized video-based motion tracking device for objective, instant, and automated assessment of laparoscopic skill in the operating room. Summary Background Data: The assessment of technical skills is fundamental to recognition of proficient surgical practice. It is necessary to demonstrate the validity, reliability, and feasibility of any tool to be applied for objective measurement of performance. Methods: Nineteen subjects, divided into 13 experienced (performed >100 laparoscopic cholecystectomies) and 6 inexperienced (performed <10 LCs) surgeons completed LCs on 53 patients who all had a diagnosis of biliary colic. Each procedure was recorded with the ROVIMAS video-based motion tracking device to provide an objective measure of the surgeon's dexterity. Each video was also rated by 2 experienced observers on a previously validated operative assessment scale. Results: There were significant differences for motion tracking parameters between the 2 groups of surgeons for the Calot triangle dissection part of procedure for time taken (P = 0.002), total path length (P = 0.026), and number of movements (P = 0.005). Both motion tracking and video-based assessment displayed intertest reliability, and there were good correlations between the 2 modes of assessment (r = 0.4 to 0.7, P < 0.01). Conclusions: An instant, objective, valid, and reliable mode of assessment of laparoscopic performance in the operating room has been defined. This may serve to reduce the time taken for technical skills assessment, and subsequently lead to accurate and efficient audit and credentialing of surgeons for independent practice.

Aggarwal, Rajesh; Grantcharov, Teodor; Moorthy, Krishna; Milland, Thor; Papasavas, Pavlos; Dosis, Aristotelis; Bello, Fernando; Darzi, Ara

2007-01-01

411

Laparoscopic ultrasound and gastric cancer  

NASA Astrophysics Data System (ADS)

The management of gastrointestinal malignancies continues to evolve with the latest available therapeutic and diagnostic modalities. There are currently two driving forces in the management of these cancers: the benefits of minimally invasive surgery so thoroughly demonstrated by laparoscopic surgery, and the shift toward neoadjuvant chemotherapy for upper gastrointestinal cancers. In order to match the appropriate treatment to the disease, accurate staging is imperative. No technological advances have combined these two needs as much as laparascopic ultrasound to evaluate the liver and peritoneal cavity. We present a concise review of the latest application of laparoscopic ultrasound in management of gastrointestinal malignancy.

Dixon, T. Michael; Vu, Huan

2001-05-01

412

Hemostasis in laparoscopic renal surgery  

PubMed Central

Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion.

Hassouna, Hussam A.; Manikandan, Ramaswamy

2012-01-01

413

Is expertise in pediatric surgery necessary to perform laparoscopic splenectomy in children? An experience from a department of general surgery.  

PubMed

Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a monocentric experience and to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in a department of general surgery. 57 consecutive LSs have been performed in a pediatric population between January 2000 and October 2010. There were 33 females and 24 males with a median age of 12 years (range 4-17). Indications were: hereditary spherocytosis 38 cases, idiopathic thrombocytopenic purpura 10, sickle cell disease (SCD) 6, thrombocytopenic thrombotic purpura 2 and non-hodgkin lymphoma 1 case. Patients were operated on using right semilateral position, employing Atlas Ligasure vessel sealing system in 49 cases (86%) and Harmonic Scalpel + EndoGIA in 8. In 24 patients (42.1%), a cholecystectomy was associated. Two patients required conversion to open splenectomy (3.5%). In three cases, a minilaparotomy was performed for spleen removal (5.2%). Accessory spleens were identified in three patients (5.2%). Complications (8.8%) included bleeding (two), abdominal collection (one) and pleural effusion (two). There was no mortality. Average operative time was 128 min (range 80-220). Average length of stay was 3 days (range 2-7). Mean blood loss was 80 ml (range 30-500) with a transfusion rate of 1.7% (one patient). Laparoscopic spleen surgery is safe, reliable and effective in the pediatric population with hematologic disorders and is associated with minimal morbidity, zero mortality, and a short length of stay. Ligasure vessel sealing system shortened operative time and blood loss. On the basis of the results, we consider laparoscopic approach the gold standard for the treatment of these patients even in a department of general surgery. PMID:22241167

Guaglio, Marcello; Romano, Fabrizio; Garancini, Mattia; Degrate, Luca; Luperto, Margherita; Uggeri, Fabio; Scotti, Mauro; Uggeri, Franco

2012-01-13

414

Suprapubic approach for laparoscopic appendectomy  

PubMed Central

Objective: To evaluate the results of laparoscopic appendectomy using two suprapubic port incisions placed below the pubic hair line. Design: Prospective hospital based descriptive study. Settings: Department of surgery of a tertiary care teaching hospital located in Rohtas district of Bihar. The study was carried out over a period of 11months during November 2011 to September 2012. Participants: Seventy five patients with a diagnosis of acute appendicitis. Materials and Methods: All patients underwent laparoscopic appendectomy with three ports (one 10-mm umbilical for telescope and two 5 mm suprapubic as working ports) were included. Operative time, conversion, complications, hospital stay and cosmetic results were analyzed. Results: Total number of patients was 75 which included 46 (61.33%) females and 29 (38.67%) males with Mean age (±Standard deviation {SD}) at the time of the diagnosis was 30.32 (±8.86) years. Mean operative time was 27.2 (±5.85) min. One (1.33%) patient required conversion to open appendectomy. No one patient developed wound infection or any other complication. Mean hospital stay was 22.34 (±12.18) h. Almost all patients satisfied with their cosmetic results. Conclusion: A laparoscopic approach using two supra pubic ports yields the better cosmetic results and also improves the surgeons working position during laparoscopic appendectomy. Although, this study had shown better cosmetic result and better working position of the surgeon, however it needs further comparative study and randomized controlled trial to confirm our findings.

Singh, Manish K.; Kumar, Mani K.; Mohan, Lalit

2013-01-01

415

Robot-assisted laparoscopic choledochojejunostomy  

Microsoft Academic Search

Background: Endoscopic stenting is the treatment of choice for palliative relief of biliary obstruction by a periampullary tumor. If treated surgically, a choledochojejunostomy and Roux-en-Y diversion is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. Robotic systems may enhance dexterity and vision and might therefore support

J. P. Ruurda; K. W. van Dongen; J. Dries; I. H. M. Borel Rinkes; I. A. M. J. Broeders

2003-01-01

416

Laparoscopic repair of epiphrenic diverticulum.  

PubMed

Epiphrenic diverticula (ED) are a rare clinical entity characterized by out-pouchings of the esophageal mucosa originating in the distal third of the esophagus, close to the diaphragm. The proportion of diverticula reported symptomatic enough to warrant surgery is extremely variable, ranging from 0% to 40%. The natural history of ED is still almost unknown and the most intriguing question concerns whether or not they all need surgical treatment. From 1993 to 2010 35 patients underwent surgery at our institution. Eleven patients were treated via a thoracotomic approach alone and were excluded from present study. The remaining 24 patients formed our study population. Seventeen patients (48.6%) underwent surgery via a purely laparoscopic approach, and received a diverticulectomy + myotomy + antireflux procedure. Seven patients (23%), with ED positioned well above inferior pulmonary vein, were treated via a combined laparoscopic-thoracotomic approach: they all underwent diverticulectomy + myotomy + an antireflux procedure. Mortality was nil. The overall morbidity rate was 25%. A suture leakage occurred in 4 patients (16.6%) and they were all conservatively treated. Patients' symptom scores decreased from a median of 15 to 0 (P = 0.0005). Laparoscopic surgery for ED is effective, but given the not negligible incidence of complications such suture-line leakage, should be considered only in symptomatic patients or in event of huge diverticula. A tailored combined laparoscopic-thoracotomic approach may be useful in case of ED located high in mediastinum or with large neck. PMID:23200079

Zaninotto, Giovanni; Parise, Paolo; Salvador, Renato; Costantini, Mario; Zanatta, Lisa; Rella, Antonio; Ancona, Ermanno

2012-01-01

417

Laparoscopic-assisted colon resection.  

PubMed

The popularity and success of laparoscopic biliary tract surgery have persuaded surgeons to explore other applications for rigid endoscopic surgery. From July 1990 to February 1993 a total of 65 patients (mean age 57 years; range 41-82) underwent attempted laparoscopic colon resection. Indications for surgical intervention included cancer (39), adenomatous polyps (14), diverticulosis (10), stricture (1), and foreign-body perforation (1). A laparoscopic-assisted technique whereby the specimen was removed and the anastomosis was completed outside of the abdomen was used in all patients. A dilated umbilical opening was used for right-sided lesions and a left-lower-quadrant muscle-splitting incision for descending and sigmoid colon resections. Two patients required conversion to open laparotomy. There were no deaths and only four complications (pneumonia 1, urinary tract infection 1, prolonged ileus 1, and subfascial abscess 1). The mean postoperative stay was 4.4 days (range 3-8 days) and the average interval for return to normal activity was 8 days. Laparoscopic-assisted colon resection appears to be a safe and beneficial option for many patients with pathologic disorders of the large intestine. Future clinical trials are needed to fully determine the appropriateness of this procedure in patients with localized malignancies. PMID:8153858

Zucker, K A; Pitcher, D E; Martin, D T; Ford, R S

1994-01-01