Technique Of Laparoscopic Cholecystectomy Research Articles

Single-Incision Laparoscopic Cholecystectomy Using a Set of Novel Needle Instruments.

Although the technique of single-incision laparoscopic cholecystectomy (SILC) has improved remarkably, problems such as limited exposure and instrument collision persist. We describe a new SILC technique that uses a set of specially-designed needle instruments. Fifty-six patients with benign gallbladder disease underwent SILC using the newly-designed needle assembly instruments (NAIs). The NAIs comprise an needle assembly exposing hook for operative field exposure and an needle assembly electrocoagulation hook for dissection. During the operation, the NAIs were assembled and disassembled before and after gallbladder removal within the abdominal cavity. The operative efficacy and postoperative complications of this procedure were evaluated. SILC was completed successfully in 52 cases, and four cases (7.14%) required an additional trocar. There were no conversions to open surgery. The mean operative time was 48.2 ± 21.8min, and the mean operative bleeding volume was 10.5 ± 12.5mL. Minor postoperative complications occurred in 3 cases, including 2 cases of localized fluid accumulation in the abdominal cavity and 1 case of pulmonary infection, and all of them recovered after conservative treatment. There was no occurrence of bile leak, abdominal bleeding, bile duct injury and incisional hernia. The medical cost of each case was saved by approximately $200. The abdominal scars produced by the needle instruments were negligible. NAIs can make SILC safer, more convenient, and less expensive.

Clinical application of magnetic anchor technique in laparoscopic cholecystectomy: the first retrospective study in China.

Magnetic anchor technique (MAT) is frequently used in laparoscopic cholecystectomy. However, there are few reports on its clinical application in China. In this study, we retrospectively analyzed the clinical application of MAT in laparoscopic cholecystectomy in China. 25 patients (4 males, 21 females) who underwent laparoscopic cholecystectomy assisted by MAT at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled from November 2020 to March 2021. Their records were retrospectively analyzed. The magnetic anchor device was independently designed and developed by the authors and consisted of the anchor magnet and magnetic grasping apparatus. Surgical time, intraoperative blood loss, intraoperative accidents, operator experience, postoperative incision pain score, postoperative complications, and other indicators were evaluated and analyzed. All patients successfully underwent laparoscopic cholecystectomy, including 3 cases of MAT-assisted transumbilical single-port LC, 16 cases of MAT-assisted 2-port LC and 6 cases of conventional 3-port LC. The median operation time was 50 min (range 30-95 min); intraoperative bleeding was less than 30 ml. The median score of surgical incision on day 1 and 3 after the operation was 3 (range 1-4) and 1 (range 1-3), respectively. All patients had no intraoperative bile duct injury, vascular injury, postoperative bleeding, bile leakage, biliary stricture and other complications. No adverse events (such as injury to adjacent organs or failure of the magnetic anchor device) occurred either during or after the operation. The MAT-assisted laparoscopic cholecystectomy appears to be safe, feasible and effective and exhibits unique assistance in transumbilical single-port laparoscopic cholecystectomy.

Safe laparoscopic cholecystectomy technique and timing for acute cholecystitis: a study in India

Background: Acute cholecystitis patients undergo laparoscopic cholecystectomy (LC) within 72 hours or 6 weeks to 12 weeks after onset is widely considered the optimal timings for LC. However, there has been no clear consensus about it. We aimed to determine safe technique of LC for acute cholecystitis within 72 hours or any time of presentation with no delay in surgery. Methods: Medical records of 100 patients who underwent standard LC were reviewed retrospectively. Patients were divided into group 1, patients undergoing LC within 72 hours of onset; group 2, between 4 days to 14 days; group3, between 3 weeks to 6 weeks; group 4, more than 6 weeks. Results: No significant differences existed between groups in conversion rate to open surgery, operation time, blood loss, or postoperative morbidity, and hospital stay. However, total hospital stays in groups 1 and 2 was significantly shorter than that in groups 3 and 4 (p<0.01). In addition, the total hospital stay in group 3 was also significantly shorter than that in group 4 (p<0.01). Conclusions: Best timing of LC for acute cholecystitis may be within 72 hours, and there is no need to delay LC in patients presenting after 72 hours and with safe technique of dissecting at infundibulum retrieval of stones and cystic duct stump closure with catgut loop there is no significant difference observed retrospectively.

Modified optical port entry site for laparoscopic cholecystectomy: Our experience.

<b><br>Introduction:</b> The four-port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of optical port entry site modification.</br> <b><br>Material and Methods:</b> To assess the feasibility and safety of laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 60 patients at Seth GSMC and KEM Hospital, India between Jan 2022 and July 2022. Our study offered the benefit of a flexible optical port entry site, using a 5 mm optical trocar instead of the conventional 10 mm trocar. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds.</br> <b><br>Results:</b> 60 cases of gallstone disease were subjected to the new technique of laparoscopic cholecystectomy over seven months. 39 cases were females and 21 were males. The age range of our patients was between 20 and 55 years with a median age of 39 years. Mean Body mass index 30 (range 25 - 37). The mean operative time was 30 min (range 15 - 45 min) and a follow-up period ranged from 10 to 14 months. No cases were converted to open. We did not encounter any untoward mishaps during surgery.</br> <b><br>Discussion:</b> Our modification of the optical port placement and size received good results and patient satisfaction. Moreover, the placement of the port at a site further from the midline and umbilicus decreases the risk of development of trocar site incisional hernia.</br&gt.

Prospects for the introduction of simulation training in the educational process for the training of future surgical doctors

Annotation. The relevance of the issue concerning the exploration of prospects for implementing simulation-based learning into the educational process for training future surgeons is driven by the contemporary demand for alternative communicative approaches, effective tools, methods, and enriching traditional medical education with modern teaching technologies. The article analyses the effectiveness of using simulation equipment in virtual surgery and the feasibility of integrating simulation technologies into medical educational programs for preparing future surgeons, using the example of the simulation training center at V.N. Karazin Kharkiv National University. The appropriateness of utilizing the Lap Mentor technique for mastering practical surgical skills in 6th-year students during the “Cholecystectomy” training module is assessed through the practice of laparoscopic cholecystectomy technique in the university's simulation center. Comparing the research results reveals that students in the experimental group, who employed simulation methodologies to acquire practical and theoretical skills, had a relatively higher percentage of mastery of essential knowledge in the chosen subject. The results described in the article once again emphasize the advantages of using simulation-based learning in medical education practice while preparing highly skilled surgical professionals. This is due to the development of professional competencies and the acquisition of clinical experience during independent operations, which occur without harm to the patient and without subjecting the learner to stressful factors. The prospects for further developments lie in integrating simulation-based learning into the training process for the fundamentals of laparoscopic surgery, which has become a necessary condition and an integral part of ensuring the effectiveness of practical training for future surgeon physicians.

Comparison between Open Cholecystectomy, 4-Port Laparoscopic Cholecystectomy and One-Port Laparoscopic Cholecystectomy: A Literature Review

Cholecystectomy is the most commonly performed surgical procedure to treat gallbladder disease. In recent decades, the technique of laparoscopic cholecystectomy has been developed, which has proven to be a less invasive alternative with better results compared to traditional open cholecystectomy. However, laparoscopic one-port cholecystectomy has recently been introduced as an even less invasive variant. In this literature review article, a comprehensive comparison is made between open cholecystectomy, 4-port laparoscopic cholecystectomy and one-port laparoscopic cholecystectomy, evaluating the epidemiology, clinical significance, definition, surgical technique, advantages and complications of each approach.

Two Port and Two Suture Modified Laparoscopic Cholecystectomy Technique

Two Port and Two Suture Modified Laparoscopic Cholecystectomy Technique

Indocyanine green direct injection into gallbladder during laparoscopic cholecystectomy: a safety method to outline biliary anatomy

Background One of the most frequently done operations in digestive surgery is the laparoscopic cholecystectomy (LC). Despite several safety precautions and guidelines, iatrogenic bile duct damage (BDI) during LC still occurs at a very high incidence. Fluorescence of biliary system may minimise surgical difficulties that might emerge owing to unintended harm to the common bile duct. Methods We outline a technique for directly injecting Indocyanine Green (ICG) into the gallbladder to clarify the architecture of the cystic duct and common bile duct. Fifty patients who underwent elective laparoscopic cholecystectomy participated in the study, which was a randomised controlled clinical trial. Patients who had intraoperative direct injection of ICG into the gallbladder were chosen at random using closed envelope technique, then using near-infrared fluorescence (NIF) imaging during LC) and controls (who underwent standard LC technique) Twenty five patients in each limb. Patients were studied pre-operative, intraoperative & postoperative. 50 patients in all, 25 of whom received LC with intracholecystic ICG injection, and 25 of whom underwent standard LC without the use of ICG, were included in our study. Results ICG dye was successful to delineate extrahepatic biliary anatomy well in 20 cases out of 25, while without ICG, 9 cases out of 25 were without clear delineation of common bile duct intraoperative even if cystic duct was clear enough to avoid complications in both groups . Operative Time average in cases with ICG-assisted LC was 78±15.0 min which was less than the average of time consumed in LC without ICG to dissect cystic duct and visualize critical view of safety, 101±11.87 min Conclusion Direct gallbladder ICG infusion enables quick extrahepatic biliary system imaging and clarifies the dissection, increasing protection against BDI and reducing intraoperative dissection time.

The technique of laparoscopic and robotic extended cholecystectomy for gallbladder cancer

The application of minimally invasive surgery for gallbladder cancer (GBC) is yet controversial. This article discusses the techniques of laparoscopic and robotic extended cholecystectomy. A 69-year-old male diagnosed with cT1-2N0 GBC underwent laparoscopic surgery, and a 55-year-old male with cT2N1 GBC underwent robotic surgery after preoperative chemotherapy. Nonanatomical partial hepatectomy with lymphadenectomy was performed. Liver parenchymal dissection was performed using Cavitron Ultrasonic Surgical Aspirator laparoscopically and Maryland bipolar dissector and Harmonic scalpel robotically. The operation time was 180 and 220 minutes, and the estimated blood loss was 140 and 130 mL, respectively. The final pathologies were pT1bN0 and pT2aN1, for which patients received adjuvant chemotherapy. There was no evidence of recurrence at 33 and 18 months without complications. Both laparoscopic and robotic extended cholecystectomy can be safely performed with the robotic surgical system as an effective alternative for GBC requiring liver resection with radical lymphadenectomy.

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.

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model.

The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. LC can be performed using different techniques, although the use of EBVS is highly recommended.

Integration of ICG-fluorescence cholangiography into the safety system of laparoscopic cholecystectomy

Is evaluating the possibility of integrating ICG-fluorescent cholangiography into the general safety system for laparoscopic cholecystectomy to prevent damage to the extrahepatic bile ducts by working out the methodological aspects of navigation technologies. The analysis of literature data on various approaches to improve the perioperative identification of anatomical structures during laparoscopic cholecystectomy, including the ICG-fluorescent cholangiography, was carried out. This program was implemented during the provision of elective surgical care to 24 patients with cholelithiasis who underwent laparoscopic cholecystectomy with ICG-fluorescent navigation. The developed program included: preoperative assessment of the anatomy of the biliary tree using MRCP; intraoperative technique of safe laparoscopic cholecystectomy with mandatory application of the concept of «critical view of safety» (CVS), which allows the most effective identification of the necessary anatomical structures; the use of ICG-fluorescent cholangiography, which allows to improve the control of anatomical structures at all stages of the operations. The first experience of using ICG-fluorescent cholangiography testifies to the high informative value of the method, the possibility and prospects of integrating the technology into a comprehensive safety system during laparoscopic cholecystectomy.

Minimally Invasive Approaches for Cholecystectomy

Abstract Surgical removal of the gallbladder is cholecystectomy. In Western countries, laparoscopic cholecystectomy (LC) is widely used procedure. Single-incision LC (SILC), mini LC (MLC) these surgeries developed by doctors, also natural orifice transluminal endoscopic surgery to lessen the invasiveness of the treatment. The goal of this study was to see how effective these novel less invasive techniques for LC are in treating gallstone disease. The current literature is inadequate for a proper management of new LC procedures. None of these methods have shown to be superior to traditional LC. SILC is now not recommended since it is linked to the predominance of bile duct damage also incisional hernia. Even though hybrid transvaginal cholecystectomy is becoming more popular in objective practice, cholecystectomies are still experimental. As a result of the fact that it is standardized, because MLC is standardized and nearly identical to traditional laparoscopic surgery, it may provide limited benefits without increasing postoperative problems, making it suitable for routine elective cholecystectomy. The technological issues could be addressed by modifying new surgical equipment that needs to grow with the nuances of SILC and cholecystectomy. Regardless of where these treatments may be used in the upcoming days, robotization may be required to make them the standard of care.

Laparoscopic fluorescence imaging technique for visualizing biliary structures using sodium fluorescein: the result of a preclinical study in a porcine model.

Near-infrared fluorescence imaging has been recently applied in the field of hepatobiliary surgery. Our objective was to apply blue-light fluorescence cholangiography during laparoscopic surgery. Therefore, we designed a preclinical study to evaluate the feasibility of using blue-light fluorescence for cholangiography in a porcine model. Five millimeters of sodium fluorescein (SF) solution was administered into the gallbladder of 20 male 3-way crossbred (Landrace × Yorkshire × Duroc) pigs in laparoscopic approach. The biliary tree was observed under blue light (a peak wavelength of 450 nm) emitted from a commercialized light-emitting diode (LED) light source (XLS1 extreme, Chammed). In 18 of 20 porcine models, immediately after SF solution was administered into the gallbladder, it was possible to visualize the biliary tree under blue light emitted from the LED light source. This study provided a preclinical basis for using blue-light fluorescence cholangiography using SF in laparoscopic surgery. The clinical feasibility of blue-light fluorescence imaging techniques for laparoscopic cholecystectomy remained to be demonstrated.

The Comparison of Two-port Laparoscopic Cholecystectomy Technique and Standard Four-port Technique

The Comparison of Two-port Laparoscopic Cholecystectomy Technique and Standard Four-port Technique

Adoption of Critical View of Safety versus Infundibular Technique in Laparoscopic Cholecystectomy: A comparative study

Background: Laparoscopic cholecystectomy (LC) is the most common elective surgery performed by a general surgeon. Although being a routine procedure, classical pitfalls as misperception of intraoperative anatomy is one of the leading causes of bile duct injuries (BDI). The critical view of safety (CVS) in LC can be a new safe technique for identification of anatomy to reduce such a risk. Objective: To assess the efficacy of CVS in LC compared with the traditional infundibular technique. Methods: This comparative study included 344 patients who suffered from symptomatic gall stones. Patients have been grouped into two groups: group A (172 patients) operated utilizing the traditional infundibular technique and group B (172 patients) by CVS technique. Preoperative patient assessment, operating time and intraoperative and postoperative events including hospital stay, were recorded. Those patients who were unfit and or with bleeding disorders were excluded from the study. Postoperatively, patients were assessed using clinical examination for the possible complications. Results: The main perioperative complications bleeding and bile leak were significantly reported in infundibular group 6.98% and 9.88% respectively compared to 0.58% and 1.74% in CVS group respectively. Postoperatively, both intra-abdominal collection and bile leak were significantly lower in CVS group (1.16% and 1.74%, respectively) than in infundibular group (7.58% and 6.98%, respectively). Furthermore, hospital stay was significantly less in CVS group (1.8±2.7 days) compared to infundibular group (3.14±2.8 days). Conclusion: Using the CVS is associated with shorter operative time, less frequent peri- and postoperative complications and shorter hospital stay compared with infundibular technique. Keywords: Laparoscopic cholecystectomy, critical view of safety (CVS) Citation: Abdulhassan BA, Noman ZK, Hamdawi MA. Adoption of critical view of safety versus infundibular technique in laparoscopic cholecystectomy: A comparative study. Iraqi JMS. 2022; 20(2): 262-268. doi: 10.22578/IJMS.20.2.14

EGS P32V Laparoscopic transcystic Antegrade Biliary Stenting

Abstract Background Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis including pancreatitis. Symptomatic gall stones patients have up to 20% risk of having common bile duct (CBD) stones too. Although, guidelines have been laid down for management of suspected CBD stones, in practice there is a lot of variability and lack of standardisation. The waiting list for Magnetic resonance cholangiopancreatography (MRCP) is long, resulting in delayed treatment and increased length of hospital stay. Similarly, pre-operative endoscopic retrograde cholangiopancreatography (ERCP) can also increase the length of hospital stay due to long waiting lists, limited availability and overall risk of complications as high as 30%. Hence, the role of on-table cholangiogram (OTC) while performing laparoscopic cholecystectomy has been explored. The guidelines state that OTC should be performed in fit for surgery patients, without pre-operative investigations for diagnosing CBD stones. We have been practising early cholecystectomy with on-table cholangiogram (during the index admission), with selective insertion of antegrade biliary stent in patients with choledocholithiasis. We facilitate ERCP with stent removal and clearance of CBD stones after 4 weeks post-operatively. We aim to present our technique of laparoscopic antegrade biliary stent insertion. Methods We follow the standard four-port technique for Laparoscopic cholecystectomy. Following dissection of Calot's triangle and visualisation of ‘critical view of safety’, an on-table cholangiogram is performed using a standard technique. If CBD stones are visualised, a transcystic antegrade stenting is done by Seldinger technique (without clearing the CBD of stones). The cholangiogram catheter is removed and flex-tip ureteric catheter is inserted transcystically. Through the ureteric catheter a flex-tip guidewire is inserted into CBD till its tip is visualised in the duodenum, under C-arm guidance. The ureteral catheter is then withdrawn carefully with guidewire placed satisfactorily. A double pig tail end biliary stent is rail-roaded over the guidewire, using a pushing catheter fashioned appropriately. As soon as the tip of the stent is visualised beyond the ampulla (in the X-ray), the guidewire and pushing catheter are withdrawn. The curling up of both ends of the stent is visualised and confirmed through C-arm guidance. Thereafter the procedure of cholecystectomy, as standard, is completed. Results The results of this procedure were analysed from 2014 to 2017, and subsequently published in 2018. Conclusions This technique does not involve skills required for CBD exploration. Hence, can be performed by general surgeons with expertise in minimal access surgeries, as it does not involve a steep learning curve. This technique is safe, reliable and cost-effective. It also decreases delays in biliary decompression, in-hospital stay and ensures timely treatment.

Magnetic Anchor Technique in Laparoscopic Cholecystectomy: A Single-Center, Prospective, Randomized Controlled Trial

Magnetic Anchor Technique in Laparoscopic Cholecystectomy: A Single-Center, Prospective, Randomized Controlled Trial

10-mm versus 5-mm umbilical port in laparoscopic cholecystectomy: A comparative study in a medical college in Eastern India

Background: Laparoscopic cholecystectomy (LC) the most common laparoscopic surgery performed worldwide. The surgical technique of LC has undergone many modifications; in respect to reduction of port sizes or number of ports. Conventionally, 10-mm 30° laparoscope is being used but, 5-mm 30° laparoscopes through 5-mm umbilical port (modified LC) are also being utilized by many surgeons worldwide. Aims and Objectives: The aims of this study were to compare the outcome of conventional LC with modified LC, in terms of feasibility, safety, and efficacy. Materials and Methods: This prospective randomized study was carried out in the Department of Surgery, ESIC-PGIMSR, Joka during June 2017–December 2018. One hundred and fifty patients of diagnosed symptomatic gall stone disease were randomly allocated into two study groups. Group-I contained 75 patients, who underwent LC by conventional method whereas, and 75 patients in Group-II underwent LC by modified method. Follow-up was done at 6 weeks, 6 months, and 1 year after surgery. Data were analyzed by appropriate statistical tests. Results: The mean operating time and mean pain score over umbilical wound were found to be statistically significant. However, no significant differences were obtained in terms of average hospital stay, post-surgical complications such as post-site bleeding, cystic artery bleeding, biliary spillage, and wound infection. Only one patient in the 10-mm umbilical port group, having body mass index of 31 developed umbilical port-site hernia. Regarding wound cosmesis, no significant difference was obtained. Conclusion: Performing LC with a 5-mm 30° laparoscope through 5-mm umbilical port is a safe and feasible option for laparoscopic surgeons.

Safe Laparoscopic Cholecystectomy Techniques in Difficult Cases

Safe Laparoscopic Cholecystectomy Techniques in Difficult Cases