Laparoscopic Cholecystectomy Group Research Articles

[Progress and controversy in minimally invasive approach to radical cholecystectomy for gallbladder cancer].

Surgical treatment is one of the most important forms of treatment in patients with gallbladder cancer. With the development of minimally invasive technology, the feasibility, safety and efficacy of minimally invasive approaches such as laparoscopic or robotic-assisted radical cholecystectomy for gallbladder cancer have received continuous attention.For patients with an early T-stage (Tis or T1a), laparoscopic simple cholecystectomy is safe and economical, with a good prognosis for postoperative patients, and it has been widely accepted and performed. Radical resection of advanced gallbladder cancer requires resection of the gallbladder, its liver bed, and other neighboring invaded organs, as well as clearance of regional lymph nodes, which requires experienced gallbladder cancer treatment teams to strictly grasp the indications, select appropriate patients, and formulate a good surgical strategy to ensure the therapeutic effect. Meanwhile, robot-assisted radical resection for gallbladder cancer has been performed in a few centers and shows good clinical potential, but more high-quality studies are needed to further evaluate its value in gallbladder cancer treatment.

Feasibility of robotic cholecystectomy at an academic center with a young robotic surgery program: a retrospective cohort study with umbrella review

Laparoscopic cholecystectomy (LC) has been standard of care for surgical treatment of benign gallbladder pathology for decades. With the advent of robotic surgical technology, robotic cholecystectomy (RC) has gained attention as an alternative to conventional laparoscopy. This study introduces a single-surgeon experience with laparoscopic versus robotic cholecystectomy and an umbrella systematic review of the outcomes of both approaches. A retrospective chart review was performed at a single institution on a prospectively maintained database of patients undergoing laparoscopic or robotic cholecystectomy for benign gallbladder pathology. An umbrella systematic review was conducted using PRISMA methodology. A total of 103 patients were identified; 61 patients underwent LC and 42 underwent RC. In the RC cohort, 17 cases were completed using a four-port technique while 25 were completed using a three-port technique. Patients undergoing RC were older compared to the LC group (44.78 vs 57.02 years old; p < 0.001) and exhibited lower body mass index (29.37 vs 32.37 kg/m2, p = 0.040). No statistically significant difference in operative time or need for postoperative ERCP was noted. Neither this series nor the umbrella systematic review revealed significant differences in conversion to open surgery or readmissions between the LC and RC cohorts. Three-port RC was associated with reduced operative time compared to four-port RC (101.28 vs 150.76 min; p < 0.001). Robotic cholecystectomy is feasible and safe at a young robotic surgery program in an academic center setting and comparable to laparoscopic cholecystectomy clinical outcomes.

Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis

Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of vascular and biliary injuries. In this study, we aimed to identify the preoperative parameters with predictive value for surgical difficulties. A retrospective study of 255 patients with acute cholecystitis admitted in emergency was performed between 2019 and 2023. Patients in the difficult laparoscopic cholecystectomy (DLC) group experienced more complications compared to the normal LC group (33.3% vs. 15.3%, p &lt; 0.001). Age (p = 0.009), male sex (p = 0.03), diabetes (p = 0.02), delayed presentation (p = 0.03), fever (p = 0.004), and a positive Murphy sign (p = 0.007) were more frequently encountered in the DLC group. Total leukocytes, neutrophils, and the neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the DLC group (p &lt; 0.001, p = 0.001, p = 0.001 respectively). The Tongyoo score (AUC ROC of 0.856) and a multivariate model based on serum fibrinogen, thickness of the gallbladder wall, and transverse diameter of the gallbladder (AUC ROC of 0.802) showed a superior predictive power when compared to independent parameters. The predictive factors for DLC should be assessed preoperatively to optimize the therapeutic decision.

Comparative Analysis of Haemodynamic and Capnographic Changes in Laparoscopic Cholecystectomy and Open Cholecystectomy: A Randomised Clinical Study

Introduction: Laparoscopic cholecystectomy is now preferred over the open procedure due to advantages such as reduced blood loss and shorter hospital stays. However, concerns have been raised regarding the potential for increased Intra-abdominal Pressure (IAP) during laparoscopic procedures, which may impact haemodynamic stability and respiratory parameters. However, there is a lack of comprehensive analysis directly comparing both surgical approaches from both haemodynamic and capnographic perspectives. Aim: To compare the haemodynamic and capnographic changes between laparoscopic and open cholecystectomy. Materials and Methods: This randomised clinical study was conducted at Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India from May 2021 to June 2022. The study included 300 patients scheduled for cholecystectomy, divided into two groups: Laparoscopic Cholecystectomy (LC) Group I (n=150) and Open Cholecystectomy (OC) Group II (n=150). Haemodynamic parameters, including Pulse Rate (PR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Oxygen Saturation (SpO2 ), were recorded. Capnographic parameters, such as End-Tidal Carbon Dioxide (EtCO2 ) levels, were also measured at regular intervals. Data analysis was performed using the student’s t-test and Chi-square test with Statistical Package for Social Sciences (SPSS) version 21.0 software and Microsoft excel. Results: There were no significant differences in age, body weight, and sex distribution between Group I and Group II. However, significant differences were observed in PR and SBP at 15 minutes (PR: 101.46 and 95.86; SBP: 148.57 and 140.97), 30 minutes (PR: 104.52 and 99.82; SBP: 141.28 and 136.07), and 45 minutes (PR: 102.52 and 97.70; SBP: 140.59 and 133.95) (p-value &lt;0.01). Highly significant differences were observed in MAP and EtCO2 postinsufflation at 15 minutes (MAP: 118.38 and 108.61; EtCO2: 36.48 and 33.89), 30 minutes (MAP: 111.11 and 106.01; EtCO2: 41.02 and 36.15), 45 minutes (MAP: 110.73 and 103.48; EtCO2: 42.65 and 38.36), and 60 minutes (MAP: 106.08 and 101.45; EtCO2: 41.10 and 38.21) (p-value &lt;0.01). DBP showed high significance at 15 minutes (103.21 and 93.23), 30 minutes (96.74 and 92.57), and 60 minutes (93.14 and 86.92) (p-value &lt;0.01), and significant (p-value=0.01) at 45 minutes (95.53 and 87.59). Oxygen saturation showed significance (p-value &lt;0.05) at 15 minutes (99.93 and 100). Conclusion: The present study demonstrated a significant increase in both haemodynamic and capnographic parameters, even in American Society of Anaesthesiologists (ASA) Grade-I and Grade-II patients undergoing laparoscopic cholecystectomy compared to the open surgical technique. These findings emphasise the need for careful monitoring during laparoscopic procedures.

Effectiveness of conservative management versus laparoscopic cholecystectomy in the prevention of recurrent symptoms and complications in adults with uncomplicated symptomatic gallstone disease (C-GALL trial): pragmatic, multicentre randomised controlled trial

ObjectiveTo assess the clinical and cost effectiveness of conservative management compared with laparoscopic cholecystectomy for the prevention of symptoms and complications in adults with uncomplicated symptomatic gallstone disease.DesignParallel group, pragmatic...

A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy

IntroductionWe sought to compare medium-term outcomes between robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC) using validated quality of life (QoL) and pain assessments. Materials and MethodsPatients who underwent RC or LC between 2012 and 2017 at a single academic institution were examined. Cases converted to open were excluded. Patients were contacted by telephone in 2019 and completed two standardized surveys to rate their QoL and pain. ResultsOf those screened, 122 (35.8%) completed both surveys. Ninety three (76.2%) underwent RC and 29 (23.8%) underwent LC. The groups (RC versus LC) were similar based on mean age (47.9 versus 45.5 y, P = 0.48), gender (66.7% versus 72.4% female, P = 0.56), race (86.0% White/5.4% Black versus 72.4% White/13.8% Black, P = 0.2), insurance status (98.9% versus 100.0% insured, P = 0.58), median body mass index (31.8 versus 31.3, P = 0.43), and median Charlson Comorbidity Index (1 versus 0, P = 0.14). Fewer RC patients had a history of steroid use compared to LC (16.1% versus 34.5%, P = 0.03). No overall significant difference in QoL was demonstrated. LC group had higher severity of “tiring-exhausting pain” (P = 0.04), “electric-shock pain” (P = 0.003), and “shooting pain” (P = 0.05). The “overall intensity” of pain in the “gallbladder region” between the groups was similar at the time of follow-up (P = 0.31). ConclusionsQoL over 2-7 y following time of surgery is comparable for robotic-assisted versus conventional laparoscopic cholecystectomies. The laparoscopic approach may be associated with a higher severity of subset categories of pain, but overall pain between the two approaches is comparable.

Ultrasound-Guided Transversus Abdominis Plane Block Versus Intraperitoneal Instillation of Bupivacaine after Laparoscopic Cholecystectomy – A Randomized Control Trial

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

Can gallbladder wall thickness and systemic inflammatory index values predict the possibility of conversion from laparoscopy to open surgery?

This study aims to develop an objective marker that predicts the risk of conversion from laparoscopy to open surgery using gallbladder wall thickness and inflammatory index values. A total of 2,920 cholecystectomy patients were screened, including those whose operations were converted to open and those who underwent laparoscopy. A total of 700 cholecystectomy patients who met the study criteria were included in the study. The same team of surgeons performed all operations. The conversion probability from laparoscopic to open cholecystectomy was calculated using the ratio obtained by evaluating inflammatory markers and gallbladder wall thickness (K). The preoperative complete blood count and abdominal ultrasound data of the patients were obtained from our university patient registry system. Age, neutrophil count, gallbladder wall thickness, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), KxNLR, and KxPLR values were all significantly higher in the conversion from laparoscopy to open surgery group compared with the laparoscopic cholecystectomy group. According to the ROC analysis performed on the gallbladder wall thickness values according to the probability of conversion to open surgery, the cutoff value was determined as >3 mm. Gallbladder wall thickness >KxPLR >KxNLR was defined as the diagnostic value order according to the area under the curve. The results of this study showed that gallbladder wall thickness effectively determines the probability of conversion from laparoscopy to open cholecystectomy and multiplying the gallbladder wall thickness (mm) by NLR increased the sensitivity.

COMPARISON OF SAFETY OF MINILAPAROSCOPIC AND CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY

Abstract. Aim: to assess the safety of mini-laparoscopic cholecystectomy (MLC) compared to traditional laparoscopic cholecystectomy (LC) based on a critical view of safety (CVS).&#x0D; Materials and methods: an analysis of 46 video recordings of MLC surgeries and 156 LC surgeries performed for chronic calculous cholecystitis and gallbladder polyps between 2015 and 2022 was conducted, using the concept of CVS and the quality of its achievement. An analysis of anatomical variations was also performed.&#x0D; Results and discussion: the average age was 38.5 years in the MLC group and 53.8 years in the LC group, with an average operation time of (59.4±2.13) minutes and (63.01±2.01) minutes, respectively. CVS was achieved in 97.8 % of cases in MLC and 93.0 % in LC. Anatomical variations were present in 31.1 % of cases in MLC and 30.1% in LC. There were no complications of MLC, conversions from MLC to LC, or open surgery.&#x0D; Conclusions: The frequency of achieving CVS in MLC was higher than in LHE (97.8 % vs. 93.0 %). Anatomical variations of the biliary system should always be considered for the safe cholecystectomy. MLC is a safe technique that is not inferior to standard LCE in elective surgery in patients with a normal BMI, and at the same time has better cosmetic results.

The first experience of using the "Senhance" robotic surgical system during cholecystectomy

The aim of our study was to evaluate the differences in intra­operative and postoperative outcomes of cholecystectomy using the Senhance robotic platform and laparoscopic cholecystectomy. A retrospective analysis of medical cases history of patients who underwent cholecystectomy from December 2021 to February 2022 was conducted. The treatment outcomes of patients with chronic calculous cholecystitis who underwent robotic cholecystectomy (RC) were compared with those who underwent laparoscopic cholecystectomy (LC). Robotic cholecystectomy was performed using the Senhance robotic platform. The RC and LC groups were matched for age, sex, body mass index and compared for the duration of the operation and hospital stay. For normally distributed data, the mean and standard deviation, determined using the Shapiro-Wilk test (p-value&gt;0.05), were applied. Median and interquartile range (IQR) were also used. Difference between cohorts - 95% confidence interval (95% Confidence Interval) were estimated for normally distributed data. Data analysis was performed using standard summary statistics on the Jamovi 2.2.5 platform. Data were processed using application program packages. All surgical procedures were performed by two surgeons from Odesa National Medical University. Robotic cholecystectomy was performed on 18 pa­tients and laparoscopic cholecystectomy was performed on 20 patients. There were no statistically significant differences between the groups in terms of length of hospital stay, blood loss or complications. There were no bile duct injuries, intra­operative complications, or conversions in either group. The only statistically significant difference was the total time under anesthesia (p&gt;0.05), which was longer in the robotic cholecystectomy group. Cholecystectomy using the Senhance robotic platform was found to be safe, with an average operative time of 35.2±5.0 minutes, while the duration of laparoscopic cholecystectomy was 32.2±3.3 minutes. The study results showed that robotic cholecystectomy using the Senhance system is safe and effective. The use of robotic systems can improve precision and control during surgery, reduce blood loss and complications.

Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: A meta-analysis.

Patients with cholecysto- and choledocholithiasis usually undergo endoscopic retrograde cholangiopancreatography (ERCP)/-endoscopic sphincterotomy followed by laparoscopic cholecystectomy (LC). However, differences in the timing of LC after the ERCP may alter the post-operative outcomes. The aim of this study was to compare the effect of early (≤3 days) or delayed LC (>3 days) following ERCP on the post-operative outcomes. A comprehensive search of the 3 databases PubMed, EMBASE and the Cochrane Library was performed. Articles related to LC at different time-points after ERCP were retrieved. Dichotomous and continuous outcomes were analyzed by risk ratio (RR) and mean difference, and RevMan was used to analyze each group. A total of 7 studies, including 5 randomized controlled studies and 2 retrospective studies, involved a total of 711 patients. There were 332 patients in early LC group and 379 in delayed LC group. The conversion rate was lower in the early LC group compared to the delayed LC group (RR 0.38, 95% confident interval 0.19 to 0.74, P = .005, I2 = 0%). Early LC resulted in a shorter operation time (RR -6.2, 95% CI -27.2 to -5.2, P = .004, I2 = 97%) and fewer complications (RR 0.48, 95% CI 0.29 to 0.79, P = .004, I2 = 17%). Subgroup analysis found that there were no significant differences in the conversion rate (RR 0.61, 95% CI 0.25 to 1.45, P = .26, I2 = 0%) or complications between the early LC group and the delayed group who underwent LC after 1 month. Early LC after ERCP is the preferred treatment for patients with concurrent cholecysto- and choledocholithiasis due to improved clinical outcomes as compared to those who undergo delayed LC.

557 Laparoscopic versus robotic cholecystectomy: a meta-analysis to differentiate between postoperative outcomes

Abstract Objective Robotic cholecystectomy (RC) may be an option to replace conventional laparoscopic cholecystectomy (LC) due to several reported advantages. The objective of this study is to compare the postoperative surgical outcomes in patients undergoing RC versus LC. Materials and methods RCTs reporting postoperative outcomes in patients undergoing RC versus LC were selected from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results Two RCTs on 196 (113 patients in RC group and 83 patients in LC group) patients were found suitable for meta-analysis according to the inclusion criteria. In the random effects model analysis, the duration of operation [standardised mean difference -15.83, 95%, CI (-22.99, -8.67), Z = 4.33, p &amp;lt; 0.0001] was shorter in the LC group. However, the risk of bile leak [standardised mean difference 3.15, 95%, CI (0.69, 14.44), Z = 1.48, p = 0.14] and postoperative complications [standardised mean difference -0.48, 95%, CI (0.10, 2.33), Z =0.91, p = 0.36] were statistically similar between RC and LC groups. There was no heterogeneity (Tau 2 = 0.09; Chi 2 = 1.06, df = 1; (p = 0.30; I 2 = 6 %) between included RCTs. Conclusion RC failed to prove any clinical advantage over LC for postoperative outcomes including longer duration of operation. These findings are insufficient to draw a stronger conclusion due to the paucity of RTCs and a major multicentre RCT is required to strengthen the existing evidence.

FTP5.13 Laparoscopic cholecystectomy is more cost effective than robotic cholecystectomy: a systematic review of published studies

Abstract Objective Robotic cholecystectomy (RC) has been proven safe and postoperative outcomes have also been quoted to be equivalent to conventional laparoscopic cholecystectomy (LC). The objective of this review to evaluate the cost effectiveness of RC compared to LC. Materials and methods All types of comparative studies reporting the cost of RC versus LC were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4. Results Four comparative studies (one randomised trial and 3 retrospective studies) on 817 patients undergoing RC versus LC were found and deemed suitable for analysis. There were 559 patients in the LC group and 258 patients in the RC group. In the random effects model analysis, LC was associated with the reduced cost [standardised mean difference -5.39, 95%, CI (-8.97, -1.81), Z = 2.95, P=0.003] compared to RC. However, there was significant heterogeneity (Tau2 = 13.06; Chi2 = 583.52, df = 3; (p &amp;lt; 0.00001; I2 = 99%) among included studies. Conclusion The LC seems to be more cost effective compared to RC in terms of procedural cost. However, due to statistically significant heterogeneity among included studies and paucity of the randomised, controlled trials, these findings should be taken cautiously. A Major multicentre randomised, controlled trial is needed to validate these findings.

A comparative study of umbilical port versus epigastric port for gall bladder extraction in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. Postoperative pain is important factor that decide requirement of injectable analgesics and post-operative hospital stay. Gall bladder (GB) can be extracted from umbilical or epigastric port. Excessive manipulation during GB extraction can cause postoperative pain. Methods: Study was carried out in 60 patients between January 2022 to December 2022, including patients who have symptomatic gall bladder stone and required laparoscopic cholecystectomy. Patients with perforated GB and required emergency laparoscopic cholecystectomy and patient having GB carcinoma and required elective laparoscopic radical cholecystectomy and patients requiring laparoscopy converted to open cholecystectomy were not included in the study. In this study, patients were randomly allocated in two groups: group A (n=30) includes laparoscopic cholecystectomy with GB retrieval from epigastric port and group B (n=30) includes laparoscopic cholecystectomy with GB retrieval from umbilical port. Author have compared two groups in terms of intraoperative time, postoperative pain, wound infection and port site hernia development. Results: This study shows that there is no significant difference in intraoperative time, wound infection and port site hernia development between two groups but there is significant less postoperative pain in group B patients with GB retrieval from umbilical port. Conclusions: In laparoscopic cholecystectomy, there is no significant difference in GB retrieval from umbilical port and epigastric port in terms of intraoperative time, wound infection and port site hernia development. But GB retrieval from umbilical port reduce post-operative pain in comparison to epigastric port GB retrieval.  

Lower abdominal approach in laparoscopic cholecystectomy: A propensity score-matching analysis and prospective cohort study

BackgroundClassic laparoscopic cholecystectomy) using multiple ports is a widely used method with excellent surgical outcomes. However, the resulting wounds do not meet the cosmetic needs of patients. Therefore, this study aimed to find a new minimally invasive surgical method for invisible wounds while maintaining surgical safety through a new port site. MethodsIn this prospective cohort study, we used propensity score matching analysis to evaluate the perioperative outcomes of multiport laparoscopic cholecystectomy using articulating devices with the lower abdominal approach. We performed a propensity score matching analysis of prospectively maintained data from 228 patients who underwent classic laparoscopic cholecystectomy using straight instruments and laparoscopic cholecystectomy with a lower abdominal approach using articulating devices between January and October 2022. A single surgeon performed all operations included in the study. We evaluated several perioperative outcomes. ResultsNo differences were found in potential confounding factors, such as sex, age, admission type, previous abdominal surgery, and medical comorbidities, between the 2 groups after propensity score matching. In the classic laparoscopic cholecystectomy group, the mean operation time was shorter (43.73 ± 23.71 vs 50.60 ± 9.75 min; P < .04). No significant difference was noted in the 2 groups’ numerical rating scale scores for pain, body mass index, and incidence of postoperative complications. The mean length of hospital stay was longer for patients who underwent classic laparoscopic cholecystectomy (4.27 vs 2.07 days; P = .064). The lower abdominal laparoscopic cholecystectomy group had delayed defecation after surgery. ConclusionRegarding surgical outcomes and minimal invasiveness, lower abdominal laparoscopic cholecystectomy is a feasible cholecystectomy method.

Outcomes of an enhanced recovery after surgery (ERAS) program to limit perioperative opioid use in outpatient minimally invasive GI and hernia surgeries.

Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don't require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients' perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P = 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P = 0.014). We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.

Short- and long-term outcomes of laparoscopic radical gallbladder resection for gallbladder carcinoma: A multi-institutional retrospective study in Japan.

Laparoscopic resection of gallbladder carcinomas remains controversial. This study aimed to evaluate the surgical and oncological outcomes of laparoscopic procedures for suspected gallbladder carcinoma (GBC). In this retrospective study, data regarding suspected GBC treated with laparoscopic radical cholecystectomy before 2020 in Japan, was included. Patient characteristics, surgical procedure details, surgical outcomes, and long-term outcomes were analyzed. Data of 129 patients with suspected GBC who underwent laparoscopic radical cholecystectomy were retrospectively collected from 11 institutions in Japan. Among them, 82 patients with pathological GBC were included in the study. Laparoscopic gallbladder bed resection was performed in 114 patients and laparoscopic resection of segments IVb and V was performed in 15 patients. The median operation time was 269 min (range: 83-725 min), and the median intraoperative blood loss was 30 mL (range: 0-950 mL). The conversion and postoperative complication rates were 8% and 2%, respectively. During the follow-up period, the 5-year overall survival rate was 79% and the 5-year disease-free survival rate was 87%. Recurrence was detected in the liver, lymph nodes, and other local tissues. Laparoscopic radical cholecystectomy is a treatment option with potential favorable outcomes in selected patients with suspected GBC.

Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients

Aim: To assess which treatment modality, Patients with AC who are at a high risk should have a cholecystectomy performed using or percutaneous catheter drainage. Methodology: Sixty people were included in this study because they got diagnosed with acute calculous cholecystitis. Both the procedure of laparoscopic cholecystectomy and percutaneous catheter drainage were offered to them at random. Results: In terms of the need for further surgery, there was a statistically significant difference between the groups as there were 2 (6.7%) who needed re-intervention in laparoscopic cholecystectomy group and 14 (46.7%) in percutaneous catheter drainage group (p=0.001*), recurrent biliary disease as there were 2 (6.7%) in laparoscopic cholecystectomy group and 17 (56.7%) in percutaneous catheter drainage group (p&lt;0.001*) and total length of hospital stay as the mean of laparoscopic cholecystectomy group was 4.9 (±2.77 SD) while in percutaneous catheter drainage group was 10.67 (±6.62 SD).Conclusion: Cholecystectomy with laparoscopic is favored over percutaneous drainage for high-risk individuals with acute cholecystitis. When compared to percutaneous catheter drainage, laparoscopic cholecystectomy decreased significant complications but did not affect fatality rates.

Comparison of laparoscopic radical cholecystectomy and open radical cholecystectomy for stage III gallbladder cancer

Comparison of laparoscopic radical cholecystectomy and open radical cholecystectomy for stage III gallbladder cancer

LAPAROSCOPIC CHOLECYSTECTOMY VS OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY CONDUCTED AT ONE OF THE TERTIARY CARE CENTRES IN NOTHRERN INDIA.

Background: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no denitive data on its use in AC has been published. To Objective: compare the results of laparoscopic cholecystectomy (LC) with those of open cholecystectomy (OC) in the treatment of acute cholecystitis. Materials and Methodology: A prospective study was conducted among 30 patients who have taken surgical treatment for acute cholecystitis by taking their prior consents at Surgery Department, Career Institute OF Medical Sciences, Lucknow for 1 year. The patients underwent surgery within 72 hours of the onset of symptoms. The pa tients were selected for LC or OC depending on the surgeon's experience in laparoscopic surgery. Operating time, rate of con- version from LC to OC, complications, and length of hos pital stay were the main outcomes which were noted in both procedures. Conversion from LC to OC was necessary in 15% of the patients. The Results: mean operating time was 77 minutes for the OC group and 88 minutes for the LC group (P&lt;.001). Complications occurred in 14% of the patients in the LC group and in 23% of the patients in the OC group, with no signicant differences between the 2 groups (P=.06). The number of moderate or severe com- plications was similar in both groups, whereas mild com- plications were more common in the OC group (P&lt;.02). The length of the hospital stay averaged 8.1 days for the OC group and 3.3 days for the LC group (P&lt;.001). Laparoscopic cholecystectomy is a s Conclusions: afe, valid alternative to OC in patients with acute cholecystitis. The technique has a low rate of complications, implies a shorter hospital stay, and offers the patient a more comfortable postoperative period than OC