Experience Of Laparoscopic Cholecystectomy Research Articles

Exploring Serum Lipid Profile Changes in Patients During Laparoscopic Choecystectomy

Background: For quite some time, cholecystectomy has been perceived as a safe surgical procedure, often with limited attention given to potential secondary effects. It's worth noting that the gallbladder plays a significant role as a regulatory component in coordination with vital metabolic pathways responsible for maintaining equilibrium in the body. When the gallbladder is removed, bile from the liver flows directly into the upper portion of the intestine. Therefore, this study aims to evaluate the impact of laparoscopic cholecystectomy on the serum lipid profile of patients. Material and methods: A total of 60 patients diagnosed with gallstones were enrolled in this study. Preoperative blood samples were collected from all patients under sterile conditions, two hours prior to their scheduled surgery, to evaluate their lipid profile. Results: The preoperative mean Total Cholesterol (TC) levels were measured at 160.5 mg%, while postoperatively, they showed a slight decrease to 150.8 mg%. Similarly, the mean High-Density Lipoprotein Cholesterol (HDL-C) levels before surgery were 42.1 mg%, and they decreased to 40.8 mg% after the procedure. In contrast, the mean Triglyceride (TG) levels saw an increase from 180.8 mg% preoperatively to 200.8 mg% postoperatively. Notably, the comparison of mean TC and TG levels before and after the surgery yielded significant results, indicating changes in these lipid parameters following laparoscopic cholecystectomy. Conclusion: Patients undergoing laparoscopic cholecystectomy experience noteworthy changes in their serum lipid profile.

EGS P16 Laparoscopic cholecystectomy for acute cholecystitis versus diagnostic laparoscopy for suspected appendicitis: comparative time of admission to theatre and impact on reaching national guidance

Abstract Background Early laparoscopic cholecystectomy for acute cholecystitis reduces intra-operative complications. National AUGIS guidelines therefore propose laparoscopic cholecystectomy should be performed within 72 hours of diagnosis. Locally, laparoscopic cholecystectomies for acute cholecystitis are preferentially performed within Emergency General Surgery (EGS) theatres whilst diagnostic laparoscopies for suspected appendicitis within CEPOD. Access to EGS is anecdotally challenging when compared with CEPOD. Patients with acute cholecystitis may subsequently experience longer times from admission to theatre. This project aimed to compare patient timelines from admission/booking to theatre and evaluate the impact on reaching national AUGIS guidance, intra-operative findings and intra-operative drain insertions. Methods Retrospective analysis of patient records at a single tertiary centre was performed. All patients that underwent a laparoscopic cholecystectomy for imaging-confirmed acute cholecystitis (n=66) alongside patients who underwent diagnostic laparoscopy +/- appendicectomy for suspected acute appendicitis (February-June 2022) (n = 62) were included. Time from admission/booking to theatre was determined and independent t-tests performed for statistical comparison. Associations between prolonged waiting times (>72 hours) and severity of intra-operative findings (Parkland scores) (ordinal regression analysis) / intra-operative drain insertion (Chi squared analysis) were analysed. Results Patients undergoing laparoscopic cholecystectomies waited significantly longer from both admission to theatre and booking to theatre compared to patients undergoing diagnostic laparoscopy for suspected appendicitis (71.4 hours vs. 33.33 hours, mean difference 38.07 hours, p=<0.001; 26.93 hours vs. 15.57 hours, mean difference 11.36 hours, p=0.002;). 63.6% of laparoscopic cholecystectomies were performed within 72 hours of admission. Waiting over 72 hours for laparoscopic cholecystectomy was not associated with increased severity of intra-operative findings (higher Parkland scores) (estimate 0.40, p=0.519) or drain insertion (Chi-squared 0.886a, p=0.347). Mean age 57.2 years (range 19-93) and 36.3 (range 8-86) for cholecystectomy versus diagnostic laparoscopy, respectively. Conclusions Patients awaiting laparoscopic cholecystectomy experience significantly longer waiting times from admission and booking to theatre when compared to those awaiting diagnostic laparoscopy for suspected appendicitis. Local concordance with national AUGIS guidance is variable and a proportion of patients with acute cholecystitis wait beyond 72 hours for laparoscopic cholecystectomy. Waiting >72 hours within this tertiary centre is not, however, reflected by intra-operative findings or intra-operative drain insertion. Completion of laparoscopic cholecystectomies within CEPOD should be considered for cases of acute cholecystitis to minimise wait times.

Retrospective analysis of a single unit experience in laparoscopic cholecystectomy in Northern Sri Lanka during the Covid-19 pandemic

Introduction: Laparoscopic cholecystectomy is a surgical procedure that removes a diseased gallbladder for various indications. It is preferred over open cholecystectomy due to fewer complications and early recovery. However, it carries different operative and postoperative complications. In addition, the availability of resources and skillful surgeons limits its use worldwide. Analysing the experience of laparoscopic cholecystectomy will enhance the training and skills and improve the surgical outcome.
 Methods: All the laparoscopic cholecystectomies done from July 2020 to July 2022 were analysed retrospectively. 
 Results: This study included eighty-seven surgeries with patients ages 8 to 84 years (mean 51.76 ±17.15). Male patients were 32.2% and females 67.8%. The indication for laparoscopic cholecystectomy was symptomatic gallstone disease in 72.4% acute/chronic cholecystitis in 14.9%, distal CBD stones in 5.7%, Gall bladder polyp in 3.4%, biliary colic in 18.4%, cholangitis in 1.2%, obstructive jaundice in 1.2% and pyocele in 1.2%. ERCP was performed by the surgeons of the same unit to manage 6.8% of the cases preoperatively and 2.2% post-operatively. Intra-operative difficulty or problems was seen in 24.13% of the cases, which included adhesions with adjacent organs in 14.9%, difficult identification of Calot's triangle in 3.4%, bile spillage 6.8% and abnormally distended gall bladder, adhered deep into the liver, and double gallbladder in 1.2% each. 1.2% of the cases needed conversion to open. Postoperative complications were noted in 20.68% of cases. 3.4% had Clavian Dindo grade I complications.
 Conclusion: Professorial unit Teaching hospital Jaffna is performing laparoscopic cholecystectomies even in the presence of limited resources. The outcomes were comparable with the international standards published up to date.

Feasibility of laparoscopic cholecystectomy for symptomatic gallstone disease with portal cavernoma: Can prior portal vein decompression be avoided?

Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression. Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed. Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20-400 mL), 105 min (60-220 min), and 2 days (1-7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time. In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.

Early vs. Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis – A Single Center Study

Introduction: Laparoscopic cholecystectomy is regarded as the gold standard for the treatment of acute cholecystitis; however the timing of the procedure is controversial. There exist studies that support both early and delayed laparoscopic cholecystectomy. Aim: The aim of the study is to determine which modality: early or delayed laparoscopic cholecystectomy is the preferred timing in the treatment of acute cholecystitis by examining: duration of hospitalization, conversion rate, duration of surgery and intraoperative, postoperative complications. Materials and Methods: This was a retrospective study of 300 patients. Laparoscopic cholecystectomy was performed within 72 hours of admission for patients in the Early LC Group. Patients in the Delayed LC group were treated conservatively and discharged They were readmitted 6-12 weeks later for elective laparoscopic. Results: The mean operating time was 83.55 mins vs. 60.72 mins in the delayed group, conversion rate in Early LC Group was 5.3% vs. 8.0 % in the delayed LC group. The mean postoperative hospital stay was 1.98 days in the earlier group and 3.35 days in the delayed group. Overall mortality was zero. Conclusion: Early laparoscopic cholecystectomy within 72 hours of symptom onset offers both medical and economic benefits and should be the preferred method for patients treated by surgeons with adequate laparoscopic cholecystectomy experience.

Use of Critical View of Safety and Proctored Preceptorship in Preventing Bile Duct Injury During Laparoscopic Cholecystectomy-Experience of 3726 Cases From a Tertiary Care Teaching Institute.

Bile duct injury (BDI) continues to occur despite technological advances and improvements in surgical training over the past 2 decades. This study was conducted to audit our data on laparoscopic cholecystectomies performed over the past 2 decades to determine the role of Critical View of Safety (CVS) and proctored preceptorship in preventing BDI and postoperative complications. All patients undergoing elective laparoscopic cholecystectomy were analyzed retrospectively. The data were obtained from a prospectively maintained database from January 2004 to December 2019. Proctored preceptorship was used in all cases. Intraoperative details included the number of patients where CVS was defined, number of BDI and conversions. Postoperative outcomes, including hospital stay, morbidity, and bile duct stricture, were noted. Three thousand seven hundred twenty-six patients were included in the final analysis. Trainee surgeons performed 31.6% of surgeries and 9.5% of these surgeries were taken over by the senior surgeon. A CVS could be delineated in 96.6% of patients. The major BDI rate was only 0.05%. This study reiterates the fact that following the basic tenets of safe laparoscopic cholecystectomy, defining and confirming CVS, and following proctored preceptorship are critical in preventing major BDI.

MANAGEMENT OF BILE DUCT INJURY IN A REFERRAL CENTER, 10 YEARS OF EXPERIENCE

Abstract Introduction Bile duct injury represents major morbidity and mortality, and in the last two decades in which laparoscopy cholecystectomy has been universally available several factors associated with bile duct injury have been described: one of them being the surgeon's training and experience in laparoscopic cholecystectomy. Some authors have reported that the training curve stabilizes the risk of bile duct injury from 1.7 to 0.17% by procedure number 50. Given that most surgical residency programs don't have enough experience in laparoscopy, this likely contributes to the development of bile duct injury. Therefore, it is important to elucidate the risk factors for bile duct injury in our country. Methods In a referral center we collected the data from 10 years of experience in bile duct repair for bile duct injury. The clinical records for 83 patients were obtained and analyzed. Results High-quality hepaticojejunostomy was performed in all 117 cases, 89.8% open, 8.5% laparoscopic and 1.7% was converted from laparoscopic to open. In 41% of patients, partial resection of the IV segment was necessary. the main post-operatory complication was surgical site infection in 19.6%, overall mortality was 3.4%. according to McDonald Classification for Group A 56.4%, Group B 28.2%, Group C 10.2%, Group D 5.2%, in long-term follow-up. Conclusions Surprisingly, the open cholecystectomy was the most common procedure associated with bile duct injury in our population. Postoperative injury detection was the most frequent, and the most common injury location was near the confluence. We obtained good long-term results even the type of injuries. The disproportion between training centers and hospitals all around the country may impact these results due to the lack of experience of the young surgeons that have only had training in laparoscopic surgery and the lack of universal laparoscopic availability for emergencies. The patients that suffer from this complication are of middle age, and there is a significant disproportion between males and females, with females being the most affected group. It has an impact on their quality of life. High-quality hepaticojejunostomy with Hepp-couinaud technique provides good long-term results, with no difference between the 1–5 year and the 6–10 year groups. The segment IV hepatectomy represents a good option to access the hilar plate. It is important to continue to expose surgeons during their residencies to open cholecystectomy. Prevention is the cheapest and safest way to decrease the incidence of bile duct injury. The implementation of high-volume centers such as ours is important to bring early and high-quality solutions to problems like these.

Management of Bile Duct Injury in a Referral Center in Mexico, 10 Years of Experience

Introduction: Bile duct injury represents major morbidity and mortality, in Mexico, for the last two decades laparoscopy cholecystectomy was universally available, Several factors associated with bile duct injury have been described: one of them is the surgeon’s training and experience in laparoscopic cholecystectomy. Some authors have reported that the training curve stabilizes the risk of bile duct injury from 1.7 to 0.17%, by procedure number 50. thus in most surgical residency programs don't have enough experience in laparoscopy, this probably contributes to the development of bile duct injury, this is why it's important to elucidate the risk factors for bile duct injury in our country. Methods: In a referral center we collect the data for 10 years of experience in bile duct repair for bile duct injury, the clinical records for 83 patients were obtained and analyzed. Results: High-quality hepaticojejunostomy was performed in all 83 cases, 90.4% open, 8.2% laparoscopic and 1.4% was converted from laparoscopic to open. In 40.3% patients, partial resection of the IV segment was necessary. the main post-operatory complication was surgical site infection in 19.2%, overall mortality was 6%. according to McDonald Classification for Group A 56.2%, Group B 28.7%, Group C 9.6%, Group D 5.5%, in long-term follow-up. Conclusions: Surprisingly the open cholecystectomy was the most common procedure associated with bile duct injury in our population, also postoperative injury detection was the most frequent, the most common injury localization was near to confluence. we obtained good long-term results even the type of injuries.Tabled 1MaleN=1619.2%FemaleN= 6780.8%Age39.70SD ± 15.27Open cholecystectomyN= 4250.7%laparoscopic cholecystectomyN= 3339.7 %converted cholecystectomyN= 89.6%Intraoperative injury detectionN= 2732.9%postoperative injury detectionN= 5667.1%T Tube post-cholecystectomyN=1214.5%Biliary stent post-cholecystectomyN= 89.6% Open table in a new tab

Laparoscopic Cholecystectomy at the Centre Hospitalier Universitaire (CHU) Mère-Enfant le “Luxembourg” in Mali for 2 Years from 2020 to 2021

Introduction: Laparoscopic cholecystectomy is a surgical technique that involves the removal of the gallbladder by laparoscopy. Its practice is timid in sub-Saharan Africa, despite the existence of risk factors such as sickle cell disease. We report our 2-year experience of laparoscopic cholecystectomy in the general surgery department of the CHU-ME Luxembourg. Materials and Method: This was a descriptive cross-sectional study from September 2019 to September 2021. The study included 64 patients with vesicular lithiasis who underwent laparoscopic cholecystectomy. Data were analyzed on SPSS software (version 25.0). Confidentiality and anonymity of the subjects were respected. Results: The frequency of cholecystectomy was 30.9%. The average age was 38.37 ± 16.94 years. The female sex was 70.3%. Obesity and sickle cell disease were found in 85.9% and 14.1% of patients. On physical examination, hepatic colic was found in 54.7% and the Murphy sign was positive in 64.1% of patients. Ultrasound diagnosis of vesicular lithiasis was made in all patients. All patients underwent laparoscopic cholecystectomy, which was retrograde in 64.1% of cases. The average procedure time was 66 minutes. No case of complication was recorded postoperatively. Conclusion: Laparoscopic cholecystectomy is a technique to be developed and supported.

Laparoscopic Cholecystectomy Experience in District General Hospital from January 2018 – October 2019

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot’s triangle. This study aimed to review our experience handling elective LC cases, (simple and difficult) as a district general hospital.

Virtual reality laparoscopic simulator

Background: Virtual reality laparoscopic simulators were introduced to provide an optimal and safe learning environment for surgical trainees. The simulators had been validated and proven to be beneficial. Materials and Methods: The aim of this study is to assess the performance of the local surgical trainees using a validated simulator and help in the development of a training program using the simulator. Prospective repeated measures study in a single center using a validated virtual reality simulator was performed. Years 1 and 2 local postgraduate surgical trainees with limited laparoscopic cholecystectomy experience were included in the study. The trainees underwent a proposed training module, and the simulator evaluated each performance. Comparison was made between the performance before and after the training module. Results: Nine surgical trainees (eight males, median age: 33 years old) with a median of 5 years of surgical experience after graduation were included in the study. The time to complete each basic laparoscopic skill improved between 26.5% and 64.3% (P Conclusion: Virtual reality laparoscopic training should be implemented as part of training as it improves certain skill sets.

Outcome of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for patients with acute cholecystitis

Background: This prospective randomized study was undertaken to to assess the outcomes of early versus delayed cholecystectomy for patient’s acute cholecystitis.Methods: 70 patients with acute cholecystitis were prospectively randomized to either an early laparoscopic cholecystectomy (n=35) or a delayed laparoscopic cholecystectomy group (n=35). The mean operative time, conversion rate, total hospital stay, intra-operative and post-operative complications, average hospital cost were evaluated between the two groups.Results: A total of 70 patients were enrolled, 35 patients in each group. There was no significant difference in the conversion rates (early, 8.57% vs delayed, 5.71%) and postoperative complications (early, 25% vs delayed, 20%). At the cost of an increased operating time (early, 81 minutes vs delayed, 78 minutes) and blood loss (early, 180.33ml vs delayed, 108.00 ml), early laparoscopic cholecytectomy significantly shortened the total hospital stay (early, 1.5 days vs. delayed, 7.95 days) and average hospital cost (early 9240 INR vs delayed, 12251 INR).Conclusions: The safety and efficacy of early and delayed laparoscopic cholecystectomy for acute cholecystitis were comparable in terms of morality, morbidity and conversion rate. However early laparoscopic cholecystectomy allows significantly shorter total hospital stay and reduction in days away from work at the cost of longer operating time and blood loss and offers definitive treatment at initial admission. Moreover it avoids repeated admissions for recurrent symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.

Experience in laparoscopic cholecystectomy in Nobel Medical College, Nepal

Objective: A laparoscopic cholecystectomy (LC) is the treatment of choice for gallbladder diseases. The aim of this study is to analyze laparoscopic cholecystectomies performed by a single surgeon over 8 years at Nobel Medical College Teaching Hospital and Research Centre Pvt. Ltd. of Biratnagar, Nepal (NMCTH). Methods: We performed a retrospective analysis of 7557 patients that underwent a LC by a single surgeon, from October 2010 to July 2018. We divided it into 3 groups that include data of every three years. Results: The hospital stay, operation time and conversion rates were decreased by years of experience. Female patients outnumbered male (M:F=1:3.7) patients in this study. The hospital stay (3 days), operation time (21 min), conversion (0.3%) and complications (1.9%) rates decreased from Group 1 to Group 3 (p<0.05). Conclusion: As surgical experience increased with a rising number of cases, the conversion rate, complications, hospital stay and mean operation time decreased. Key words: cholecystectomy, laparoscopy, elective, conversion, complications, mortality, gallstone, cholecystitis

English

English

Surgical Simulation: Markers of Proficiency

Surgical simulation has become an integral component of surgical training. Simulation proficiency determination has been traditionally based upon time to completion of various simulated tasks. We aimed to determine objective markers of proficiency in surgical simulation by comparing novel assessments with conventional evaluations of technical skill. Categorical general surgery residents completed 10 laparoscopic cholecystectomy modules using a high-fidelity simulator. We recorded and analyzed simulation task times, as well as number of hand movements, instrument path length, instrument acceleration, and participant affective engagement during each simulation. Comparisons were made to Objective Structured Assessment of Technical Skill (OSATS) and Accreditation Council for Graduate Medical Education Milestones, as well as previous laparoscopic experience, duration of laparoscopic cholecystectomies performed by participants, and postgraduate year. Comparisons were also made to Fundamentals of Laparoscopic Surgery task times. Spearman's rho was utilized for comparisons, significance set at >0.50. University of Missouri, Columbia, Missouri, an academic tertiary care facility. Fourteen categorical general surgery residents (postgraduate year 1-5) were prospectively enrolled. One hundred forty simulations were included. The number of hand movements and instrument path lengths strongly correlated with simulation task times (ρ 0.62-0.87, p < 0.0001), FLS task completion times (ρ 0.50-0.53, p < 0.0001), and prior real-world laparoscopic cholecystectomy experience (ρ -0.51 to -0.53, p < 0.0001). No significant correlations were identified between any of the studied markers with Accreditation Council for Graduate Medical Education Milestones, Objective Structured Assessment of Technical Skill evaluations, total previous laparoscopic experience, or postgraduate year level. Neither instrument acceleration nor participant engagement showed significant correlation with any of the conventional markers of real-world or simulation skill proficiency. Simulation proficiency, measured by instrument and hand motion, is more representative of simulation skill than simulation task time, instrument acceleration, or participant engagement.

Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

ASSESSMENT OF FEASIBILITY AND COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS

Abstract :Introduction: From the era of absolute contraindication to the phase of preferred treatment, the technique of laparoscopic cholecystectomy advances with time. Here, we report our experience of laparoscopic cholecystectomy in 20 patients of liver cirrhosis. In our institute, laparoscopic cholecystectomy is the preferred choice for cholelithiasis in cirrhotic patient.Methods: In last 2 years, 180 laparoscopic cholecystectomies were performed and 20 patients were cirrhotic. Their data analyzed retrospectively in terms of preoperative optimization, operative technique and results.Results: Laparoscopic cholecystectomy was completed successfully in 19 patients and one was converted to open. Mean operative time was 54 minutes. No additional port was required in all cases. Calot’s first dissection was performed in 18 patients and fundus first technique was used in 2 patients due to unclear anatomy. Liver bed bleeding was present in 16 patients, which was controlled effectively. Subhepatic drain was placed in 12 patients. There was no mortality. Morbidity in two patients was worsening of ascites in one; and incisional hernia in other patient which was converted to open. Port site complications were not noted in any patient and there was no evidence of intraabdominal bleeding or bile leak postoperatively. Blood and component transfusion was required in 2 patients. Average length of hospital stay was 4.8 days.Conclusion: Though laparoscopic cholecystectomy may be difficult in cirrhotic patients but it is feasible and relatively safe. It offers many advantages in cirrhotic patients and associated with low morbidity when compared with open surgery.Keywords: cirrhosis, laparoscopic cholecystectomy, difficult cholecystectomy

Initial Japanese Experience of Laparoscopic Cholecystectomy Using a New Robot-Assisted System

The object of this paper is to clarify the feasibility and safety of robot-assisted laparoscopic cholecystectomy. Acute or chronic cholecystitis is the most common disease in patients, caused by cholecystolithiasis. Minimally invasive laparoscopic surgery is often performed for treatment of cholelithiasis. We performed robot-assisted laparoscopic cholecystectomy for the treatment of 5 patients with cholecystolithiasis. The patient underwent laparoscopic cholecystectomy using the ViKY Endo-Control System (ViKY, EndoControl, Grenoble, France). The robot-controlled laparoscopic holder was placed at the right axilla. The laparoscopic operation was performed via conventional 4-port access using the ViKY system with voice activation. All patients were treated successfully by this robot-assisted laparoscopic procedure, without any complications. Mean docking time using the ViKY was 16 minutes, mean resection time of the gallbladder was 62.2 minutes, operative time was 94.6 minutes, and the mean amount of the blood loss was minimal. Our initial experience demonstrated that robot-assisted laparoscopy was feasible and safe in patients with cholecystolithiasis, providing patient advantages. We also discuss the advantages and disadvantages of robot-assisted laparoscopic surgery.

An audit of laparoscopic cholecystectomy in renal transplant patients

Background:Choleliathisis, in patients with renal transplantation, carries high risk of complications. We, at our institute, perform prophylactic cholecystectomy for aymptomatic gallstones in patients with renal transplantation.Aim:To present our experience of laparoscopic cholecystectomy in patients with kidney transplantation.Subjects and Methods:Data, in the form of, demographics, medications used, indication of transplantation, manifestation of gallstones, operative findings, duration of hospitalization, and post-operative complications were obtained and results were analyzed. briefly summarize details of statistics including the soft ware used.Results:Twenty patients have undergone laparoscopic cholecystectomy. All patients were admitted on the day of surgery. Immunosuppression regimen was not modified during hospitalization. Indications of cholecystectomy were biliary colic (8/20 patients, 40%), acute cholecystitis (8/20 patients, 40%), asymptomatic gallstones (3/20 patients, 15%), and obstructive jaundice (1/20 patients, 5%). Laparoscopic cholecystectomy was uneventful in all cases. Post-operative complications were nausea and vomiting in two patients and port site infection in one patient.Conclusion:Laparoscopic cholecystectomy, when performed in renal transplant patients, is a safe procedure.

Preliminary Experience of Laparoscopic Cholecystectomy with Gallbladder Bed Dissection for Suspected Gallbladder Cancer

Preliminary Experience of Laparoscopic Cholecystectomy with Gallbladder Bed Dissection for Suspected Gallbladder Cancer