Laparoscopic Evaluation Research Articles

A Comparative Study of Laparoscopic Skills Between Novices and Experts: How to Steepen the Learning Curve.

Introduction and aim Laparoscopic surgery has revolutionized the field of surgery over the past few decades. The learning curve in laparoscopy is known to be slow, flat, and complex. This study aims to conduct a comparative analysis of laparoscopic skills, specifically focusing on suturing, knot tying, and needle handling, between novices and experts. The purpose is to objectively quantify the disparities in skill proficiency, identify specific areas needing improvement in training curricula, and contribute to the development of more effective training methodologies for emerging laparoscopic surgeons. Methods Residents from different specialties and institutions had their laparoscopic training and evaluation sessions recorded during their curriculum and compared with the performance of experienced surgeons from the Hôtel-Dieu de France University Hospital (Beirut, LBN) during live surgeries. This comparative study was based on the universally recognized Global Operative Assessment of Laparoscopic Skills (GOALS) score and an assessment of a detailed set of laparoscopic skills and techniques used during needle handling and knot tying. Results Twenty-one tasks performed by novices and 11 tasks performed by experts were considered. A significant difference was found in the GOALS score between the two groups (experts: 23.4/25; novices: 15.9/25). Moreover, a statistically significant difference was found to be present in favor of the experts in the following skills/techniques: using thread handling and forceps rotation for needle manipulation, laying the needle on a fixed driver arm before grasping it, using needle curvature for knot tying, using upward-facing forceps convexity when tying, using an open thread loop before tying, thread handling capacity, knot tying capacity, and number of needle skills performed per task. Conclusion This study demonstrates that many micro-steps in laparoscopic suturing are more prevalent among expert surgeons than among trainees. Incorporating these micro-steps into training could significantly accelerate learning curves, enabling trainees to refine their skills more efficiently and keep pace with the latest surgical advancements in their specialties.

A Prospective Study on Laparoscopic Evaluation of Tubal Factors with Polycystic Ovarian Syndrome and Infertility in Bangladeshi Patients

Background: Laparoscopic evaluation plays a crucial role in assessing tubal factors in infertility cases coexisting with polycystic ovarian syndrome (PCOS). PCOS, characterized by hormonal imbalances and ovarian cysts, often leads to irregular ovulation and infertility. Laparoscopy allows for direct visualization of the fallopian tubes, identifying any obstructions or abnormalities that may hinder conception. Understanding the tubal status in PCOS-related infertility helps tailor treatment strategies, optimizing the chances of successful conception for affected couples. Objective: In this study or main goal is to evaluate the tubal factor pathology in case of infertile patients with diagnosed PCOS by laparoscopy. Method: This retrospective study was carried out at tertiary medical hospital from 2022 to 2023 where a total of 100 women who were diagnosed case of infertility with PCOS included in the study. Among these 68 % were primary infertility and 32% were secondary infertility. Results: During the study, in primary infertility 70.59% patient had no history of contraception. Only 8.82% had taken oral pill and 20.59% used barrier method. In secondary infertility had no history of contraception 25% had taken oral pill, 6.25% had taken IUCD and 6.25% used barrier method. Laparoscopic study of fallopian tube showed in primary infertility the tube of the right side was normal looking in 52 (76.47%), peritubal adhesion was present in 12 (17.65%) and hydrosalpinx was present in 4 (5.88%) cases. The tube of the left side was normal looking in 50 (73.53%), peritubal adhesion was present in 10 (14.71%) and hydrosalpinx was present in 8 (11.76%) cases. In secondary infertility the tube of the right side was normal looking in 16 (50.00%), peritubal adhesion was present 8 (25.00%) hydrosalpinx in 6 (18.75%) and the tube was absent in 2 case. In the left side the tube was normal looking in 20 (62.50%), peritubal adhesion was present in 8 (25.00%) and hydrosalpinx in ...

Congenital partial diaphragmatic eventration presenting with Chilaiditi’s sign: a case report

BackgroundChilaiditi’s sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.Case presentationA 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi’s sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.ConclusionsIt is obvious that Chilaiditi’s sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.

Continuation of the levonorgestrel-releasing intrauterine device among adolescents with endometriosis

Study ObjectiveTo estimate the 1-year continuation rate of the levonorgestrel-releasing intrauterine device (LNG-IUD) in adolescents with endometriosis, and the frequency at which additional systemic hormonal treatment (HT) is utilized. MethodsA retrospective cohort study was performed of patients aged 12 – 21 years who underwent laparoscopy for endometriosis and LNG-IUD insertion at a single tertiary care institution between 2018 and 2021. ResultsWe evaluated 224 adolescents (mean age=17.0, SD=1.8 years) who underwent LNG-IUD placement during laparoscopic evaluation for endometriosis. Stage I endometriosis was most common (84.4%), followed by stage II (13.0%). Of 221 with follow-up, 208 (94.1%) had HT added or continued post-surgery. The most common additional HT was norethindrone acetate (42.5%), followed by combined hormonal contraceptives (34.8%). The 1-year LNG-IUD continuation rate was 92.0%. There were 18 IUD removals (8%) by 1 year, and the median time to removal was 118 days (IQR=159; range 8-293). Use of additional HT was associated with a lower hazard of IUD removal within the first year of use (HR = 0.19, 95% CI: 0.06-0.56, p<0.001). ConclusionThe majority of adolescents used the LNG-IUD with additional systemic HT for endometriosis management. While overall continuation was high, adolescents who were using LNG-IUD and HT were more likely to continue LNG-IUD than those who were not utilizing additional HT.

Magnetic Resonance Imaging of Endometriosis: The Role of Advanced Techniques

Endometriosis is a chronic inflammatory disease that affects about 10% of women, and it is characterized by the presence of endometrial tissue outside the uterine cavity. Associated symptoms are dyspareunia, chronic pelvic pain, and infertility. The diagnosis of endometriosis can be challenging due to various clinical and imaging presentations. Laparoscopy is the gold standard for the diagnosis, but it is an invasive procedure. The literature has increasingly promoted a switch to less invasive imaging techniques, such as ultrasound and magnetic resonance imaging (MRI). The latter, also in relation to the latest technological advances, allows a comprehensive and accurate assessment of the pelvis and it can also identify sites of endometriosis that escape laparoscopic evaluation. Furthermore, MRI has been found to be more accurate than other imaging techniques in relation to its improved sensitivity and specificity in identifying disease sites, also due to the role of new emerging sequences. This article aims to review the current role of advanced MRI applications in the assessment of endometriosis.

A Retrospective Study of Leparoscopic Evaluation of Tubal Factors in Case of Infertility

Background: Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The aim of this study was to determine the role of leparoscopic evaluation of Tubal factors in case of infertility. Methods: A retrospective study was carried out at Department of Gynae and Obstetrics UHC, Dhamrai, Dhaka, Bangladesh from January to December 2023. 55 patients were selected for laparoscopic evaluation. Inclusion criteria were patients with no prior pelvic surgery, normal bimanual pelvic examination, normal semen parameters of partner and no ovulatory dysfunction. After obtaining thorough history &amp; detailed examination, patients were informed about the procedure and written informed consent was taken. Results: 55 patients underwent laparoscopy during the study period. Most patients 10 were in the age group of ˂20 yr, 15 were between 21-30 yr &amp; 20 were 31- 40 yr of age and 10 were between 36 – 40 yrs of age. Among these 55 patients 24 patients had primary infertility while 31 had presented with secondary infertility. Diagnostic laparoscopy revealed normal pelvic organs in 9 (16.3%) cases, Chronic pelvic inflammatory disease in 3 (5.4%), endometriosis in 13 (23.6%) and congenital anomalies of uterus in 1(1.8%) cases. 7.2% cases had bilateral tubal block, 27.3% had unilateral block and in 7.2% cases though the tubes were found patent significant peritubal adhesions were noted. Tubal pathology was detected in 55.5% cases of primary infertility and 42.1% cases of secondary infertility. Among those who had tubal pathology, nonspecific pelvic inflammatory disease was noted in 33.3% and genital tuberculosis was diagnosed in 2.7% cases. The most common complications were pyrexia, shoulder tip pain, nausea and vomiting. Conclusion: Laparoscopy is a safe and effective diagnostic tool in evaluating tubal status of infertile patients. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor.

Fertility-sparing treatment with conization versus radical hysterectomy in patients with early-stage cervical cancer: inverse propensity score weighted analysis

ObjectiveTo report 20 years of experience with fertility-sparing surgery for patients with early-stage cervical cancer, comparing the oncological outcomes with outcomes for those who underwent a radical hysterectomy.MethodsPatients with pre-operative...

Role of Laparoscopy in Evaluation of Various Blunt Abdominal Trauma

Introduction with Objective: The aim of the present study was to assess the role of laparoscopy in evaluation of various Blunt abdominal trauma (BTA) in tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted from 21st June 2016 to 21st December 2017 among 50 abdominal blunt trauma patients attending at Casualty Block, Dhaka Medical College Hospital, Dhaka, after obtaining requisite consent from the patients attendant. Data were collected through the assessment and investigation report of abdominal blunt trauma patients in the Casualty Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the role of laparoscopy in evaluation of various blunt abdominal trauma. Results: Most of the patients were from 21-30 years (36%) of age group followed by 11-20 years (32%). The median age of this study population is 27 years. Of the study population, 84% (n=42) were male and 16% (n=8) were female. Male-female ratio was 84:16. In this study, 62% (n=31) of patients underwent only laparoscopy and 38% of patients (n=19%) underwent laparoscopy followed by laparotomy. Perforation of gas containing hollow viscus (94.73%) is responsible for conversion of laparoscopy into laparotomy in patients with blunt abdominal trauma. Among 50 patients 14 patients (28%) developed post operative complications. Rate of wound infection was higher laparoscopy followed by laparotomy (n=11). One patient developed post operative collection following laparoscopy. The accuracy rate is 100% in laparoscopic evaluation of BTA in this study. Conclusion: laparoscopy is a useful modality for evaluating and managing hemodynamically stable blunt abdominal trauma patients. Medicine Today 2024, Vol.36 (2): 95-98

The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review

New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.

The “must” of laparoscopic evaluation in ovarian cancer. A brief review

Ovarian cancer (OC) is the fifth major factor in female mortality worldwide, for which consistent and precise assessment of its anatomical extent is recognized as a fundamental determinant in therapeutic planning as its multimodal management has evolved. Although complete surgery without residual disease is often the mainstay of OC treatment, radiological underestimation of stage can lead to futile laparotomies in presumed early-stage cases that are surgically restaged as more advanced. Despite the continuous improvement in the performance of medical imaging, its precise recognition during the classification assessment remains a challenge. With more regularity and success in the use of minimally invasive surgery, laparoscopic surgery further paves the way for a safe, feasible and more rational assessment strategy. The modality allows for recommended staging procedures to be performed while avoiding the morbidity associated with unnecessary laparotomies. The aim of this review is to provide an overview on laparoscopy assessment for ovarian cancer and the impact of its addition in therapeutic decision making.

Abstract 2877: Enhancing diagnostic precision in peritoneal cancer metastasis: Photodynamic diagnosis-guided laparoscopy in a rabbit model

Abstract Introduction: Precise diagnostic workup is crucial for developing effective treatment strategies in cancer patients. Peritoneal carcinomatosis, often missed in preoperative CT scans and conventional laparoscopy, poses diagnostic challenges. This study aimed to assess the diagnostic accuracy of staging laparoscopy using photodynamic diagnosis (PDD) with the photosensitizer phonozen activated at 405 nm in a rabbit model of peritoneal carcinomatosis. Methods: Female New Zealand white rabbits (16-20 weeks old) were utilized to establish the model through peritoneal inoculation of VX2 sarcoma cells, resulting in distinct solid-tumor nodules for laparoscopic evaluation. A customized dual-emission laparoscope, capable of both white-light and 405 nm blue-light, was employed for PDD. To minimize blue-light background interference, a 550 nm long-pass filter was placed between the laparoscope and the video camera, optimizing the process. The PDD-enhanced diagnostic laparoscopy comprised a tripartite approach: 1) initial peritoneal cavity exploration under white-light and labeling of suspect nodules, followed by 2) utilization of blue light with the long-pass filter to identify red-light emissions from distinctly labeled tumor cells, and 3) open laparotomy served to palpate the peritoneal surface and identify additional or missed tumor nodules. Results: Analysis of data from 12 rabbits with 267 tumor nodules revealed that sensitivity and specificity of diagnostic laparoscopy for detecting tumor nodules increased from 84.9% and 18.8% with white light alone to 90.8% and 25.0% when aided by PDD, respectively. These findings underscore the substantial improvement in diagnostic accuracy achievable by combining the rabbit model of peritoneal carcinomatosis with PDD in laparoscopic procedures. Conclusion: The heightened sensitivity and specificity observed in this study hold significant promise for positively impacting clinical practice, providing a more accurate and effective approach to the diagnosis and management of peritoneal carcinomatosis. Citation Format: Hyoung-Il Kim, Adriana Rivera-Piza, Sunghwan Lee. Enhancing diagnostic precision in peritoneal cancer metastasis: Photodynamic diagnosis-guided laparoscopy in a rabbit model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2877.

Risk factors associated with changes in serum anti-Müllerian hormone levels before and after laparoscopic cystectomy for endometrioma.

The objective of our study was to investigate the risk factors for a decrease in ovarian reserve in patients with endometriomas after standardized laparoscopic procedures and evaluation to provide corresponding clinical guidance for patients with fertility requirements. Anti-Müllerian hormone (AMH) levels and other clinical data from 233 patients with endometriomas and 57 patients with non-endometrioma ovarian cysts admitted to the Peking Union Medical College Hospital between January 2018 and September 2023 were prospectively analysed. The pretreatment AMH levels of the study groups were compared to assess the impact of endometrioma on ovarian reserve, and the decrease in AMH after treatment was analysed to determine potential risk factors contributing to this change. Pretreatment AMH levels did not significantly differ between patients with endometriomas and those with non-endometrioma ovarian cysts. Within the endometrioma group, older age, higher body mass index (BMI), and shorter menstrual cycles were found to be associated with decreased AMH levels prior to treatment (p<0.05). Participants presenting with bilateral cysts, advanced surgical staging, or a completely enclosed Douglas pouch demonstrated significantly lower levels of AMH prior to treatment compared to those without these conditions (p<0.05). Furthermore, their AMH levels further declined within one year after undergoing laparoscopic cystectomy (p<0.05). However, there was no difference in AMH levels after surgery between patients who successfully became pregnant and those who did not (p>0.05). Laparoscopic removal of endometriomas can adversely affect ovarian reserve, especially during bilateral cysts removal and when patients are diagnosed as having a higher stage of endometriosis, further impacting ovarian function. It should be noted that a decrease in AMH levels may not necessarily indicate an absolute decline in fertility. Therefore, it is crucial to conduct thorough patient evaluations and provide comprehensive patient education to offer appropriate guidance for fertility preservation.

A novel laparoscopic pancreaticoduodenal training model: optimization of the learning curve and simplification of postoperative complications.

Laparoscopic pancreaticoduodenectomy requires a long learning curve. A preoperative training system was established to optimize the surgeons' learning curve and reduce the incidence rate of complications at the beginning of the curve. The laparoscopic pancreaticojejunostomy model, and choledochojejunostomy and gastrojejunostomy training systems were developed, and corresponding evaluation systems were also defined. Surgeons B and C performed laparoscopic pancreaticoduodenectomy after completing training session. Surgical outcomes, postoperative complications and their learning curves were analyzed. Patients operated by surgeons B and C experienced shorter operative durations following training session than those in nontrained group (called A) ( P <0.001). B and C began entering the inflection point at the 26th and 20th case in learning curve, respectively. The incidence of postoperative pancreatic fistula in group B was 3.3%, significantly lower than 13.1% in group A ( P =0.047). Patients in group B showed significantly lower incidence of biliary-enteric anastomosis leakage (0% vs. 8.2%, P =0.029) and Clavien-Dindo classification greater than or equal to 3 (3.3% vs. 14.8%, P =0.027) compared with those in group A. The incidence of surgical site infection in groups B (3.3%, P =0.004) and C (4.9%, P =0.012) was significantly lower than that in group A (19.7%). Moreover, the length of postoperative hospital stay was significantly shorter in groups B (12.5±5.9days, P =0.002) and C (13.7±6.5days, P =0.002) compared with group A (16.7±8.5days). The laparoscopic pancreaticojejunostomy training model and evaluation system can shorten the operative duration, lower the risk of postoperative complications, and shorten the length of hospital stay.

Frequency of Endometriosis on Diagnostic Laparoscopy in Females with Secondary Infertility

Background: For endometriosis, one of the most common chronic diseases encountered in gynecological outdoors, laparoscopy, is considered as a gold-standard diagnostic tool because direct visualization of endometriotic lesions enables the medical practitioner to provide recommendations for future therapy. This study aimed to determine the frequency of endometriosis on diagnostic laparoscopy in females with secondary infertility. Methods: A cross-sectional study among 92 females was conducted at the Department of Obstetrics &amp; Gynecology, Sir Ganga Ram Hospital, Lahore, from December 2022 to June 2023. Females aged 20-45 years, presenting with secondary infertility and subjected to diagnostic laparoscopy were analyzed using a non-probability, consecutive sampling technique. Data regarding the age, BMI, residence, parity, duration of infertility, and menstrual cycle were recorded. The findings of laparoscopic diagnosis regarding endometriosis were labeled. SPSS vr26 was used. The chi-square test was used to see the impact of effect modifiers on the frequency of endometriosis, taking p≤0.05 as significant. Results: Out of a total of 92 females, (mean age 36.66±5.41years), 65 (70.7%) females were aged between 35-45 years. The mean BMI was 24.6±3.2 kg/m2 and the secondary infertility mean duration was 22.05±6.04 months while the mean parity was 2.09±0.82. Endometriosis was diagnosed among 28 (30.4%) females, in which 16 (57.1%) had a duration of infertility above 2 years (p=0.013) with parity &lt;3 (p=0.761). Conclusion: Using diagnostic laparoscopy, the frequency of endometriosis was found significant among females having secondary infertility. Laparoscopic evaluation can be helpful in the timely diagnosis and management of secondary infertility.

Laparoscopic and Hysteroscopic Evaluation of Female Infertility: A Tertiary Level Hospital Study in Bangladesh

Laparoscopic and Hysteroscopic Evaluation of Female Infertility: A Tertiary Level Hospital Study in Bangladesh

Cryptorchidism with Duplicate Vas Deferens and Epididymis: A Rare Case with Literary Review

Background: Incidence and recognition of the congenital anomalies involving vas (or) ductus deferens, also called as sperm duct, are low, particularly when duplication of the sperm duct and epididymis occurs together. These anomalies, although of rare incidence, should be considered while performing surgeries related to the spermatic cord, to prevent inadvertent damage. Case presentation: We, here, present a case of a seventeen year old boy with undescended testis on left side, where laparoscopic evaluation revealed polyorchidism. The accessory testis was removed, and histo-pathological examination confirmed duplication of the sperm duct and the epididymis. Conclusion: This case scenario highlights the importance of recognizing and managing rare urogenital anomalies during procedures involving handling of spermatic cord structures.

Patent processus vaginalis: role of ultrasound in pediatric population with unilateral inguinal hernia and other predictors.

Inguinal hernia (IH) repair is a common procedure in the daily practice of pediatric surgeons. In a developing country with limited facilities, it is important to be able to predict and diagnose contralateral patent processus vaginalis (CPPV) to avoid the risk and cost of further surgery. To assess the accuracy of ultrasound for the detection of CPPV, using laparoscopic evaluation as a confirmatory test. We also looked for various predictors of CPPV in our study population. 141 patients were included in this 2-year, cross-sectional prospective study. Inclusion criteria were unilateral inguinal hernia elective patients with no major comorbidities and aged between 2 months and 8 years. Each patient was assessed in outpatient clinics and then a pre-operative ultrasound was conducted. This was followed by laparoscopic evaluation during repair of the hernia. Of the 141 patients included, 110 (78%) were males, 121 (85.9%) were born at full term, and 96 (68.1) had right-sided hernia. Mean age was 2.64 ± 1.9 years. Ultrasound was 85.7% sensitive in the detection of CPPV, 90.8% specific, and 90.1% accurate. In our analysis of patients younger than 1 year, right-sided hernia and defect size more than 10 mm were statistically significant predictors for a CPPV. Ultrasound has a high accuracy profile and is a useful alternative in limited resource settings with restricted access to minimally invasive surgery for the prediction of CPPV. Patients younger than 1 year with a right-sided hernia or a manifested hernia defect larger than 10 mm are at a higher risk of having a CPPV.

The Cukurova score in the prediction of primary cytoreduction in ovarian cancer

ObjectivePrimary debulking surgery has been the preferred surgical route and is still considered a quality indicator for advanced ovarian cancer surgery. However, a significant number of patients are not amenable...

Comparison of laparoscopic evaluation of hepatosteatosis with ultrasound findings.

Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by abnormal liver function because of lipid accumulation. NAFLD can range from simple fatty liver, which is usually harmless, to a more severe condition called non-alcoholic steatohepatitis (NASH), which involves inflammation, liver cell damage, cirrhosis, and liver cancer. Liver biopsy is considered the gold standard for diagnosing and staging hepatosteatosis, but it is an invasive and expensive procedure. Non-invasive methods, such as ultrasound, and magnetic resonance imaging (MRI), can provide useful information without the need for an invasive procedure. This study aimed to compare laparoscopic findings of hepatosteatosis with ultrasound data to create a classification that can identify individuals with NASH in operated patients. 120 patients who applied to the General Surgery Department of Istinye University Faculty of Medicine between 06/2022 and 12/2022 were included in the study. They were evaluated for hepatosteatosis with preoperative ultrasound. Demographic, physical examination (BMI), laboratory, and radiological findings of the patients were recorded retrospectively. In addition, laparoscopy video recordings were reviewed retrospectively, and the findings were evaluated. Statistical analysis of the findings was made. The p-value was calculated using the Chi-square test; p-value <0.05 was considered statistically significant. The mean age of 120 patients was 39.04 years, the mean BMI was 34.9 kg/m², and 63.3% of them were female patients. Cholecystectomy was performed in 60 of 120 patients, and sleeve gastrectomy in 60 of them. It has been observed that there is a high correlation between the ultrasound grade and the laparoscopic stage of hepatosteatosis (r=0.849) (p<0.05). Laparoscopy results to be an effective method in the diagnosis and classification of NASH.

1158 Outcome of Hot Laparoscopic Cholecystectomy Service Evaluation in Morriston Hospital, SBUHB

Abstract Aim Symptomatic Gall Bladder disease is a common general surgery presentation. NICE guidelines recommend performing laparoscopic cholecystectomy (within 1 week of diagnosis) for patients with acute cholecystitis. Patients who had gall stone pancreatitis should have laparoscopic cholecystectomy on the index admission. Historically poor availability of theatre slots has resulted in unacceptable delays in our health board. The objective of this study was to evaluate adherence to these recommendations before and after an intervention to improve theatre access. Method A retrospective study of inpatient laparoscopic cholecystectomies between 20/06/2022 and 28/11/2022 was undertaken in Morriston Hospital. On 20/09/2022, dedicated theatre lists for laparoscopic cholecystectomy were moved from afternoon sessions to morning or all-day sessions with the intention of minimising delays. Baseline patient and operative details were captured from electronic health records. Outcomes were adherence to recommendations from NICE and time to procedure from booking and number of procedures done before and after the intervention. Result 85 patients were included (42 patients before (Group 1) and 43 after the intervention (Group 2). 100% of patient from group 1 received cholecystectomy within a week of booking compared to 86% from group 2 (P = 0.09). Mean time to procedure was 2.5 days and 3.5 days for group 1 and group 2 respectively (P = 0.076). 3.5 patients received cholecystectomy per week in group 1 as compared to 4.4 in group 2. Conclusions Changing the timing of Theatre lists from Afternoon to Morning/all day resulted in more patients receiving cholecystectomies without compromising time from booking to procedure