Conventional Laparoscopic Cholecystectomy Research Articles

Laparoscopic cholecystectomy: fundus-down approach.

Laparoscopic cholecystectomy (LC) is the primary treatment of gallstone disease. Although refinements have made it safer, bile duct injury remains more common than with the open approach. The major difference in these techniques is that open cholecystectomy approaches the gallbladder from the fundus downward, whereas conventional laparoscopic cholecystectomy proceeds in the reverse direction. A handful of fundus-down techniques appear in the literature. The use of special instruments or port sites is common. We present a technique that is safe and utilizes instruments familiar to the surgeon performing conventional LC. Fifty consecutive LCs were included in the study. The variables monitored were age, comorbidities, postoperative diagnosis, pathologic diagnosis, length of operation, hospital length of stay, and complications. The average operating time for chronic cholecystitis was 1 hour, and the average time for acute cholecystitis was less than 2 hours. Except for one early case of bleeding, in which the procedure was completed using the familiar conventional method, no complications and no unusual technical difficulties were encountered. There were no differences between conventional and fundus-down LC with regard to time and complications. This technique is safe and has several benefits: (1) standard trocar sites that offer the surgeon flexibility in the approach; (2) the ability to resect as much cystic duct as desired; and (3) utilization of standard instruments familiar to the surgeon, thus avoiding costly special instruments. The approach may offer the benefit of reducing the rate of common bile duct injury to that of open cholecystectomy.

7106 Cardiovascular and pulmonary consequences of conventional and gasless laparoscopic cholecystectomy. a comparative randomized study.

Background: The positive CO 2 pneumoperitoneum needed to create the workspace for laparoscopic surgery induces cardiovascular, neuroendocrine and renal changes. A gasless method to create the working space for laparoscopic procedures might reduce these pathophysiological changes. Aim of the study: To compare the conventional pressure pneumoperitoneum with gasless technique in regard to hemodynamic and pulmonal function, before during and after pneumoperitoneum/traction. Patients and method: Fifty-two consecutive patients fulfilling the inclusion criteria were randomly allocated to two groups conventional laparoscopic cholecystectomy(CLC) and gasless laparoscopic cholecystectomy (GLC). Data were collected from December 1, 1998 to October 1, 1999. All elective patients with symptomatic cholecystolithiasis over the age of 18 with a body mass index (BMI ) 2 concentration, expired minute volume, pulmonary static compliance. Results: To be presented.

Randomized comparison of the clinical course of gasless and conventional laparoscopic cholecystectomy

Randomized comparison of the clinical course of gasless and conventional laparoscopic cholecystectomy

Needlescopic or minisite cholecystectomy.

Needlescopic or minisite cholecystectomy is laparoscopic cholecystectomy done through tiny ports from 1.4 mm to 3 mm in size. This refinement of conventional laparoscopic cholecystectomy reduces further the invasiveness of the operation and gives an improved cosmetic effect. This series describes the result of 36 needlescopic cholecystectomies done between February 1996 and April 1997. Patients with acute cholecystitis were excluded. There were two conversions to conventional laparoscopic surgery and no conversions to open surgery. Thirty-four patients were successfully treated by this technique. Analgesic consumption and cosmetic result was superior compared to a previous published series of conventionally done cases in the same department.

Combined use of mini-laparoscope and conventional laparoscope in laparoscopic cholecystectomy: preservation of minimal invasiveness.

Mini-laparoscopic cholecystectomy using a 2-mm mini-laparoscope has been reported to be beneficial but technically difficult. This study attempted to evaluate the relative efficacy of a new method, which provides the benefits of both conventional and mini-laparoscopic cholecystectomy. From March 1997 to December 1997, 143 patients (49 men, 94 women, mean age 52.6 years, range 20-79), American Society of Anesthesiology (ASA) class I-II, underwent elective cholecystectomy by a combination of a 2-mm mini-laparoscope and 10-mm conventional laparoscope (combined lap-aroscopic cholecystectomy, C group) in National Taiwan University Hospital, Taipei, Taiwan. The entire procedure was done through four ports (one 11-mm port and three 2-mm ports). For comparison, records from 46 patients receiving mini-laparoscopic cholecystectomy (M group, 17 men, 29 women, mean age 49.0 years, range 26-76) and 139 patients receiving conventional laparoscopic cholecystectomy (L group, 47 men, 92 women, mean age 51.2 years, range 28-82) by the same operative team were included retrospectively. Mean operation time, time until first postoperative oral intake, dosage of analgesic, and postoperative hospital stay as well as possible complications were compared. No significant differences concerning the age, sex, and ASA classification were identified between all groups. The operative time of the C group (59.9 +/- 17.3 min, p = 0.420) but was significantly shorter than that of the M group (72.8 +/- 26.5 min, p < 0.001). No differences concerning the analgesic usage (0.5 +/- 0.8 unit vs. 0.4 +/- 0.7 unit, p = 0.372), postoperative oral intake (4.4 +/- 1.9 h vs. 3.3 +/- 2.3 h, p = 0.067), and postoperative hospital stay (1.7 +/- 0.7 days vs. 1.7 +/- 0.7 days, p = 0.941) were found between the C group and the M group. However, compared with the L group, analgesic usage (0.5 +/- 0.8 unit vs. 0.8 +/- 1.0 unit, p = 0.003) and time until first postoperative oral intake (4.4 +/- 1.9 h vs. 6.2 +/- 3.0 h, p < 0.001) were less, and the postoperative hospital stay (1.7 +/- 0.7 days vs. 2.0 +/- 0.9 days, p = 0.002) was significantly shorter in the C group. Combined use of the mini-laparoscope and the conventional laparoscope in cholecystectomy provides the benefits of both conventional laparoscopic and mini-laparoscopic cholecystectomy. It is easier to perform than cholecystectomy that uses the mini-laparoscope alone and results in a much smaller wound with less pain than conventional laparoscopic cholecystectomy. It is a feasible, safe procedure, and the minimal invasiveness of mini-laparoscopic cholecystectomy is preserved. It is an alternative way to deal with gallstone disease, especially for younger women, who tend to be more concerned about cosmetic outcome.

Minimally invasive needlescopic cholecystectomy.

We utilized a mini-sized grasper and retractor measuring 2.5 mm in diameter and a new mini-sized laparoscope measuring 3 mm in diameter to perform a laparoscopic cholecystectomy. A 10/12-mm trocar was inserted as the first trocar for the laparoscope and specimen extraction. Under a direct laparoscopic view, the mini-sized grasper and retractor were inserted and the laparoscopic procedures were performed mainly through the 5-mm trocar placed on the left upper quadrant as the working port. These procedures were successfully performed on five patients with a comparable operation time to that of a conventional laparoscopic cholecystectomy, but appeared to be more minimally invasive.

Laparoscopic cholecystectomy: two-port technique.

Conventional laparoscopic cholecystectomy requires four ports. The present study describes a new laparoscopic cholecystectomy technique using two ports only. Sixty-two consecutive patients with symptomatic gallstones underwent laparoscopic cholecystectomy using this two-port technique. The operation requires a straightforward laparoscope and a percutaneous sling to retract the gallbladder laterally and cephalad. The two-port method was successful in 52 patients; eight required an additional port, and two required conversion to open surgery. Our results showed that the operating time and complication rate were comparable to those in other series using the conventional laparoscopic method. The two-port method is technically more demanding, and should only be used to remove simple, uncomplicated gallbladders. The surgeon should always be prepared to insert more trocars or convert to open procedures when necessary.

LAPAROSCOPIC CHOLECYSTECTOMY AND PREVIOUS ABDOMINAL SURGERY: A SAFE TECHNIQUE

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed. In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min. This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.

Direct insertion of laparoscopic instruments at minimally invasive surgery: An alternative to the use of a trochar and cannula

SummaryIt has been routine practice at laparoscopic surgery that laparoscopic instruments be introduced into the peritoneal cavity via specially designed cannulae at standard sites. These allow easy manipulation of the instruments and replacement by others if necessary. There are, however, several disadvantages with the use of such trochars and cannulae and it may not be necessary to use them in all cases. This study was conceived to test the feasibility of using 5 mm laparoscopic instruments at laparoscopic cholecystectomy, introduced directly into the peritoneal cavity without the preliminary placement of a sharp trochar and cannula. It was found that in 10 laparoscopic cholecystectomy cases, certain laparoscopic instruments of a particular design could, after making a small skin incision, be easily introduced directly into the peritoneal cavity and used to grasp and manipulate the fundus and infundibulum of the gall bladder as at conventional laparoscopic cholecystectomy. There were no complications.