Single-site Laparoscopic Cholecystectomy Research Articles

Evolution of Cholecystectomy-Gall Bladder must be Removed not because it Contains Stones but Forms them

Normally, human bile contains enough chemicals to dissolve the cholesterol excreted by our liver. But if our liver excretes more cholesterol than the bile can dissolve, the excess cholesterol, too much bilirubin, or not enough bile salts, first form into crystals and eventually turn into stones when stored in the gall bladder. The estimated overall prevalence of cholelithiasis is 10–15% in the general population, with some differences across countries, ethnic and age groups. The good fact is most of the gall stone patients are asymptomatic. The prevalence of gall stones is around 6% of the total population in India, with a clear predominance among females with 10% and 3% in men. In India among 808 million adult population 81 million will suffer Cholelithiasis every year and a conservative 1.6 million (2%) of them would need surgery. Among American adults the prevalence of cholelithiasis is about 10% while in Western Europe the prevalence ranges from 5.9% to 21.9%. More than one million Americans are diagnosed with gallstones every year, joining about 38 million who already have the disorder. Cholecystectomy: the surgical resection and removal was and continues to be the permanent solution and the gold standard for the definitive management of symptomatic cholelithiasis. J. L. W Thudichum proposed a two-stage elective cholecystostomy in 1859, In the first stage, the inflamed gall bladder was sewed to the anterior abdominal wall through a small incision, to serve as a route for the removal of gall stone later in the second stage. Laparoscopic cholecystectomy (LC) since its inception in 1989 has become the gold standard treatment for gall stone disease. The technique of performing LC has undergone many changes and variations. Several surgeons have tried to reduce the size and number of ports to improve cosmetic and postoperative outcomes and developed their own different versions. The most recent development in technique of LC is single incision laparoscopic surgery (SILS) or single site laparoscopic cholecystectomy (SSLC). This review is a consequence of witnessing an elective Cholecystectomy and review of the prevailing cost across the country and health insurance coverage in India. As a public health problem Cholelithiasis can’t be prevented, and Cholecystectomy is needed to 1.6 million Indian adults each year costing a fortune. Currently it cannot be accessed by all, especially the poor and even lower middle socio-economic class. With overall, health insurance coverage of around 30%, that too among urbanites, mainly covered by employers in India is a public health challenge. Ayushman Bharat a national initiative launched on 23rd September 2018, a GOI health assurance initiative adapted by almost all State governments for providing accessible and affordable healthcare to the common man for secondary and tertiary care hospitalization is still in a nascent stage. Methodology: This review is based on an observation of Laparoscopic Cholecystectomy in a 3-star private hospital on a middle socioeconomic woman, followed by literature review and costs across India by the end of 2022.

Evolution of Laparoscopic Cholecystectomy: From Multiport to Single Port

Context: Laparoscopic approach with its several techniques has become the standard method for cholecystectomy over the past decades. As technical instruments have improved and varied, the interest in endoscopic surgery has turned towards minimal invasive single site access surgery with fewer instruments, thus resulting in minimal pain, minimal scarring and better cosmesis. Evidence Acquisition: A systematic literature searching of databases MEDLINE, EMBASE, and Google Scholar was done from 1982 and updated in December 2015. Search terms were “cholecystectomy”, “laparoscopic cholecystectomy”, “four port laparoscopic cholecystectomy”, “single-incision laparoscopic surgery”. Results: Four-port laparoscopic cholecystectomy was accepted as the “gold standard” in the treatment of patients with cholelithiasis before millennium. Thereafter, two-port laparoscopic cholecystectomy was reported as a novel, safe and rapid method of gallbladder removal in consecutive reports. Single-site laparoscopic cholecystectomy with non-conventional multi-channel port method was first introduced as an alternative to the standard multi-port laparoscopic cholecystectomy in adult patients in the last decade. Success rates of performing conventional four-port laparoscopic cholecystectomy were ranging from 93% to 100% and single site laparoscopic cholecystectomy was ranging from 84% to 100%. Conclusions: Currently, it has been widely accepted that laparoscopic cholecystectomy is the gold standard for cholecystectomy. Although single site laparoscopic cholecystectomy is becoming more popular with the recent advancements, conventional multiport laparoscopic cholecystectomy is being widely used as the primary treatment modality for the gallbladder removal.

Single-incision Laparoscopic Cholecystectomy: A New Retraction Technique

Background : Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot’s triangle.Surgical technique : Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS® port was placed through an open approach. We inserted a 10-mm 30o camera through the SILS® port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose® needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose® needle. This device provided retraction of the gallbladder in every direction.Conclusions : Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

Magnetically Anchored Cautery Dissector Improves Triangulation, Depth Perception, and Workload During Single-Site Laparoscopic Cholecystectomy

IntroductionThis study evaluated operative outcomes and workload during single-site laparoscopy (SSL) using a magnetically anchored cautery dissector (MAGS) compared with a conventional laparoscopic hook cautery (LAP). MethodsEach cautery was used to perform six SSL porcine cholecystectomies. For MAGS, the cautery device was inserted through the umbilical incision, magnetically coupled, and deployed; two graspers and a laparoscope were used. For LAP, two percutaneous retraction sutures, one grasper, a hook cautery dissector, and a laparoscope were used. Operative outcomes, surgeon ratings (scale, 1–5; 1 = superior), and workload (scale, 1–10; 1 = superior) were evaluated. ResultsNo significant differences were detected for operative outcomes and surgeon ratings, however, trends were detected favoring MAGS. Surgeon workload ratings were significantly better for MAGS (2.6 ± 0.2) vs. LAP (5.6 ± 1.1; p < 0.05). For MAGS, depth perception and triangulation were excellent and the safe handling protocol was followed with no complications. For LAP, the parallelism of instruments and lack of triangulation hindered depth perception, caused instrument conflicts, and resulted in two minor complications (one superficial liver laceration and one inadvertent burn to the diaphragm). ConclusionThese data suggest that using the MAGS device for SSL cholecystectomy results in equivalent (or better) operative outcomes and less workload compared with LAP.

Magnetically Anchored Cautery Dissector Improves Triangulation and Depth Perception During Single Site Laparoscopic Cholecystectomy

Magnetically Anchored Cautery Dissector Improves Triangulation and Depth Perception During Single Site Laparoscopic Cholecystectomy

Tissue Compression Analysis for Magnetically Anchored Cautery Dissector During Single-Site Laparoscopic Cholecystectomy

IntroductionThe purpose of this study was to evaluate the histological effects of dynamic abdominal wall compression using the magnetic anchoring and guidance system (MAGS) platform. MethodsCholecystectomy was performed in two nonsurvival and two survival pigs using a single-site laparoscopic (SSL) approach. A deployable MAGS cautery dissector was used to perform the entire dissection in conjunction with a laparoscope and other instruments. The abdominal wall areas corresponding to the region occupied by the MAGS platform were examined grossly and microscopically for signs of tissue damage. Gallbladder dissection time was 36 min with no complications. Compressed abdominal wall thickness was 1.4 cm. ResultsIn all four animals, a very mild skin erythema was noted immediately postprocedure but was nonvisible within 20 min. Mild peritoneal blanching was noted in two animals, and one animal exhibited a 5-mm area of petechiae. Necropsy demonstrated no adhesions. Light microscopy documented no evidence of tissue injury for all specimens. DiscussionThis study demonstrated that the use of the MAGS cautery dissector for a SSL cholecystectomy was advantageous in providing triangulation and did not result in any significant gross or microscopic tissue damage despite the thin abdominal wall of the porcine model.

T1626 Tissue Compression Analysis for Magnetically Anchored Cautery Dissector During Single Site Laparoscopic Cholecystectomy

T1626 Tissue Compression Analysis for Magnetically Anchored Cautery Dissector During Single Site Laparoscopic Cholecystectomy