Traditional Laparoscopic Cholecystectomy Research Articles

Application of 3-Step Laparoscopic Cholecystectomy in Acute Difficult Cholecystitis.

With the aging of the global population, the incidence rate of acute cholecystitis is increasing. Laparoscopic cholecystectomy is considered as the first choice to treat acute cholecystitis. How to effectively avoid serious intraoperative complications such as bile duct and blood vessel injury is still a difficult problem that puzzles surgeons. This paper introduces the application of laparoscopic cholecystectomy, a new surgical concept, in acute difficult cholecystitis. This retrospective analysis was carried out from January 2019 to January 2021. A total of 36 patients with acute difficult cholecystitis underwent 3-step laparoscopic cholecystectomy. The general information, clinical features, surgical methods, surgical results, and postoperative complications of the patients were analyzed. All patients successfully completed the surgery, one of them was converted to laparotomy, and the other 35 cases were treated with 3-step laparoscopic cholecystectomy. Postoperative bile leakage occurred in 2 cases (5.56%), secondary choledocholithiasis in 1 case (2.78%), and hepatic effusion in 1 case (2.78%). No postoperative bleeding, septal infection, and other complications occurred, and no postoperative colon injury, gastroduodenal injury, liver injury, bile duct injury, vascular injury, and other surgery-related complications occurred. All 36 patients were discharged from hospital after successful recovery. No one died 30 days after surgery, and there was no abnormality in outpatient follow-up for 3 months after surgery. Three-step laparoscopic cholecystectomy seems to be safer and more feasible for acute difficult cholecystitis patients. Compared with traditional laparoscopic cholecystectomy or partial cholecystectomy, 3-step laparoscopic cholecystectomy has the advantages of safe surgery and less complications, which is worth trying by clinicians.

A Comprehensive Analysis of Single-Incision Laparoscopic Cholecystectomy: Trends, Challenges, and Future Directions.

Single-incision laparoscopic cholecystectomy (SILC) is a minimally invasive surgical technique introduced as an advancement to laparoscopic cholecystectomy (LC). This narrative review delves into the emergence of SILC, emphasizing its distinct advantages such as improved cosmesis, reduced postoperative pain, and potentially faster recovery compared to traditional LC. The study meticulously examines current trends and challenges in SILC, including variations in techniques and their impact on patient outcomes. Furthermore, the article sheds light on the technical intricacies and longer operative times associated with SILC. It aims to contribute valuable insights to the medical community by synthesizing existing literature and recent research findings, fostering a deeper understanding of SILC, and guiding future advancements in minimally invasive surgical approaches. The discussion extends to the learning curve, complications, and a comparative analysis between SILC and traditional LC, offering a nuanced understanding of their respective strengths and limitations. The article concludes with a forward-looking perspective, exploring future directions and innovations in SILC, including advancements in surgical techniques and the integration of innovative technologies, such as robotic assistance and in vivo robots, to enhance precision and efficacy. The call for continued research into the long-term outcomes, safety, and refined patient selection criteria emphasizes the evolving landscape of SILC and its potential to shape the future of minimally invasive abdominal surgeries.

Initial experience of robotic-assisted cholecystectomy in a tertiary care teaching hospital

Abstract Background: Robotic surgery was designed to overcome some of the major limitations of laparoscopy in terms of visibility, dexterity and precision. However, its potential limitations include high costs and low tactile feedback. at a tertiary care teaching hospital. Methods: In this retrospective study, we assessed the safety and feasibility of robotic-assisted cholecystectomy using the Versius Surgical Robot System® at our tertiary care teaching hospital between 2 September 2021 and 22 August 2022. Results: Of the 30 patients studied, 11 were males. The mean body mass index of the patients was 25.7. Intraoperative complications were noted in one case (haemorrhage from the liver bed) and conversion to laparoscopic surgery was noted in the same case. The median docking time was 16 min and the median console time was 72 min. No post-operative complications were noted. Both docking time and console time significantly decreased throughout this study. Conclusions: This study shows that the robotic-assisted cholecystectomy is a promising, safe and feasible alternative to traditional laparoscopic cholecystectomy.

Robot assisted Laparoscopic Cholecystectomy- A Comparative study

Background- Robotic surgery has recently grown in acceptance and usefulness in general surgery, and it may offer superior results to laparoscopic surgery in some gastrointestinal operations. Objectives- To assess if the use of robot assistance during laparoscopic cholecystectomy is warranted when compared to traditional laparoscopic cholecystectomy. Methods- It was a retrospective record based study. All patients undergoing robotic or laparoscopic cholecystectomy between 2019 and 2022 at a single academic medical center were captured using institutional data. A total of 110 robotic surgeries were done and 1200 Laparoscopic cholecystectomies was done during the study period. The bulk of cases were primarily handled by two acute care general surgeons, who also conducted robotic and laparoscopic cholecystectomies. The institutional Clinical Data Repository provided the financial information. The study was approved by Institutional Ethics Committee. Age, sex, race, body mass index (BMI), and comorbid conditions of the patient were examined prior to surgery. SPSS was used for analysis. Results- A total of 1310 patients were identified who underwent robotic or laparoscopic cholecystectomy between 2019 and 2022 among them Robotic-assisted approach was used in 9.1% (n = 110) of cases. There were no demographic differences in age, sex, race, and body mass index (BMI). Type II diabetes mellitus, hypertension, and CHF disease were statistically significantly different between groups. Mean age (Robotic: 41 [29-56] vs. Laparoscopic: 43 [30-54] years, p = 0.11) and BMI (Robotic: 28.4 [26.6-32.4] vs. Laparoscopic: 29.2 [27.5-33.4]) were similar between groups. both operative duration was greater and hospital cost were greater in robotic-assisted cholecystectomy and it was statistically significant (p<0.05), but hospital duration of stay and 90-day related readmission rates were less in robotic-assisted cholecystectomy which was significant; 30-day readmission rates were similar between both groups. Conclusion- When compared to laparoscopic cholecystectomy, robotic cholecystectomy has longer operating times and higher hospital costs, but it is also related with shorter hospital stays and a lower readmission rate within 90 days after the index procedure. Before exploring robotic cholecystectomy, hospitals and surgeons must weigh the enhanced clinical outcomes against the time and money necessary.

Laparoscopic cholecystectomy based on Laennec approach via the cystic plate with lymphadenectomy in Calot's triangle for gallbladder neoplasms: Initial experience and technical details

BackgroundIt is still challenging to define the exact stage of early gallbladder carcinoma with preoperative imaging. Generally, subserous gallbladder is dissected for the potential early gallbladder carcinoma, which may cause incomplete tumor resection or tumor spread especially for the patients with T2 stage. Here, we reported our experience and safety of Laennec approach via the cystic plate to dissect the whole gallbladder with lymphadenectomy in Calot's triangle for accurate diagnosis and stage in gallbladder neoplasms. MethodsThe anatomical gap between Laennec capsule and the cystic plate serves as the landmark to dissect the whole gallbladder through Laennec approach. Laparoscopic cholecystectomy based on Laennec approach via the cystic plate, together with lymphadenectomy in Calot's triangle, was performed in 17 patients with gallbladder neoplasms. ResultsAll patients had less intraoperative bleeding, no gallbladder breakage, no bile leakage, and accurate intraoperative rapid pathological staging under the corresponding strategies. The duration of surgery was comparable to that of traditional laparoscopic cholecystectomy. ConclusionLaparoscopic cholecystectomy based on Laennec approach via the cystic plate, together with lymphadenectomy in Calot's triangular is safe for gallbladder neoplasms. In the future, the prospective clinical trial is going on to confirm the feasibility and effectiveness of this approach.

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).
 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.
 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.
 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.

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.

Nutritional support for patients in general surgery

The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting.
 Objective — to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols.
 Materials and methods. This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day.
 Results. We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5 times (p < 0.001), after laparoscopic hernia repair — 1.7 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.26 times (p < 0.001), after laparoscopic bariatric intervention — 1.43 times, and after laparoscopic colon intervention — 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p < 0.001), after laparoscopic hernia repair — 1.31 times (p < 0.001), after laparoscopic crurography and fundoplication — 1.68 times (p < 0.001), after laparoscopic bariatric intervention — 1.67 times (p < 0.001), and after laparoscopic colon intervention — 1.38 times (p = 0.006) stronger in the control group.
 Conclusions. Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutritional support for surgical patients has a great chance of success. In our research, early restoration of oral nutrition significantly decreases hunger and general weakness in the early postoperative period, which allows the patient quickly return to full life.

Does a prior hysterectomy complicate transvaginal/transumbilical hybrid NOTES cholecystectomy?\u2014a comparative analysis of prospectively collected data

PurposeHysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH).MethodsA total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay.ResultsPH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be “converted” to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly.ConclusionOur results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.

Comparative analysis of postoperative pain after transvaginal hybrid NOTES versus traditional laparoscopic cholecystectomy in obese patients

PurposeEven though obesity is a known risk factor for needing cholecystectomy, most research excludes patients with higher degrees of obesity. The aim of this retrospective study was to compare postoperative pain and analgesic consumption in obese patients, who underwent either transvaginal hybrid Natural Orifice Transluminal Endoscopic Surgery (NOTES) cholecystectomy (NC) or traditional laparoscopic cholecystectomy (LC).MethodsBetween 12/2008 and 01/2017, 237 NC were performed, of which 35 (14.8%) showed a body mass index (BMI) of 35 kg/m2 or more (obesity II and III according to the World Health Organization). Of these, procedural time, postoperative pain, analgesic requirements, and other early postoperative parameters were collected and compared with 35 matched LC patients from the same time period.ResultsThere were no differences in the baseline characteristics between the two groups, but we found significant benefits for the hybrid NOTES technique in terms of less pain (P = 0.006), coherent with significantly less intake of peripheral (paracetamol; P = 0.005), and of centrally acting analgesics (piritramide; P = 0.047) within the first two-day post-surgery. We also found that those in the NC group had shorter hospital stays (P < 0.001). The postoperative complication rates and the procedural time did not differ between the two groups.ConclusionWith regard to postoperative pain and analgesic requirements and without an increase in postoperative complications, obese patients experience short-term benefits from the hybrid NOTES technique compared to traditional laparoscopic cholecystectomy.

Open versus laparoscopic cholecystectomy: a comparative study on patient parameters

Background: The advent of laparoscopic surgeries have heralded a giant leap for minimally invasive surgeries and are now being used as a primary modality due to its various benefits. The use of laparoscopic surgeries has been limited only by patient related factors and in certain scenarios by lack of infrastructure availability. The present study aimed to provide a comparative review of the traditional and minimally invasive modalities.Methods: The study employed a comparative prospective randomized study model with 100 subjects divided in two groups based on modality employed. The operative and post-operative parameters were noted and presented.Results: The study displayed that the advent of post-operative complications as well as hospital stay duration was higher in traditional laparoscopic cholecystectomy cases.Conclusions: The study reiterated the long known fact that laparoscopic surgeries in gall stones is favorable from the patient perspective but is riddled with unavailability due to financial and infrastructure based concerns.

Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single centre in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirement.Methods: It was a prospective comparative study conducted in the department of surgery Smimer medical college Surat, India from July 2018 to July 2019. The study was performed on all adult patients with ultrasound documented cholelithiasis. The total number of patients studied was 50 which were divided into two groups of 25 each.Results: Demographic data were comparable for both study groups. Patients in the 3-port group had shorter mean operative time (47.3±29.8 min versus 60.8±32.3 min) for the 4-port group (p=0.04). Post-operative requirement of analgesia was less in 3 port group as compared to 4 port group. Pain visual analog scale (VAS) score, intra operative complications, post- operative complications and return to normal activity were significant in our study. Hospital stay and patient satisfaction were non- significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less analgesic requirement, early post-operative ambulance, early oral feed, and better cosmetic results.

Surgical treatment of acute cholecystitis in obese patients.

&lt;b&gt;Introduction:&lt;/b&gt; In today's technological climate, science and medicine have entered a new era. At the level of technological progress, we have identified millennia of "new" problems and diseases. If earlier diseases had a certain individuality then, in the third millennium, we face compliance and synergistic influence of diseases. Obesity is a problem of the third millennium. It is known that obesity is the main factor in the development of various chronic diseases [1-3]. With excess weight and obesity, bile is oversaturated with cholesterol, resulting in an increase of its lipogenicity index. As a result, frequency of gallstone disease increases; findings from this study document an increase of disease frequency as high as 50% to 60% [4]. In 20% of patients, housing concerns are combined with obesity [5]. Thus, obesity is one of the factors in the development of cholelithiasis and cholecystitis [6]. The presence of acute cholecystitis represents the most difficult situation for patients with gallstones. When obesity is also present, the patient's risk of surgical complications increases due to altered homeostasis and reduced reserve capacity [7]. A retrospective study of this issue [8] posed a number of questions about the possibility of influencing the course of disease in the preoperative period as well as the improvement and impact of surgical technicalities in patients with acute cholecystitis and obesity. Addressing these and additional questions is the main goal of this study. &lt;br&gt;&lt;b&gt;Aim: &lt;/b&gt;The aim of the study was to study and select the optimal method of surgery in patients with acute cholecystitis and obesity. &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; In our study, a prospective analysis was used. We analyzed 67 cases with diagnosis of acute cholecystitis and obesity; all were treated at Kyiv Regional Clinical Hospital in the period from September 2018 to March 2020. Patients with acute cholecystitis and obesity received either traditional or modified laparoscopic cholecystectomy. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Retrospective analysis indicates traditional laparoscopic cholecystectomy is technically difficult and costly in patients with acute cholecystitis and obesity. A modified laparoscopic cholecystectomy has been proposed to improve and enhance surgery in patients with acute cholecystitis and obesity. Surgical duration was shortened by 9.01 ± 0.41 minutes (p = 0.001; αα= 0.05) when a modified laparoscopic cholecystectomy was performed. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Performing a modified laparoscopic cholecystectomy reduced the duration of surgery by 9.01 ± 0.41 minutes (p = 0.001; α = 0.05), prevents development of metabolic acidosis pH 7.39 ± 0.03 vs 7.30 ± 0.005 = 0.001; αα= 0.05, pCO2 5.05 ± 0.36 vs 6.03 ± 0.38 (p = 0.02; αα= 0.05), reducing the risk of hypercoagulation. Modified laparoscopic cholecystectomy (LHE) is effective in II and III degrees of obesity (p = 0.001; α = 0.05).

Retrospective Study of Three-port versus Standard Four-port Laparoscopic Cholecystectomy: A Single Surgical Unit Experience of 1456 Patients

Introduction: Although laparoscopic surgeries have proven beyond doubt their benefit in terms of early recovery, better patient care and cost-effectiveness, the quest for reduction in either the size or number of ports still continues. Aim: To compare the safety, outcome, and advantages between three-port versus four-port Laparoscopic Cholecystectomy (LC) in acute and chronic cholecystitis. Materials and Methods: Medical records of 1456 patients that underwent LC (three- or four-port) for acute and chronic cholecystitis from January 2015 to December 2019 (60 months) were retrospectively analysed. All patients were given the same anaesthetic drugs for induction and maintenance, with standard anaesthetic protocol. The results were compared for both the techniques in terms of operating time, conversion rate, intraoperative complications, immediate postoperative complications, pain score, analgesic requirement and hospital stay. Results: Total 1456 patients underwent LC; 1282 were female and 174 were male. The mean age of the patients was 39.2 years (range 18-70 years). The three-port LC technique was performed on 816 (56.04%) patients, while the traditional four-port LC technique was performed on 640 (43.96%) patients. Visual Analog Score (VAS) in the postoperative period at six hour was 2.11±0.82 in three-port group versus 3.17±1.12 in four-port group, this suggests that there was a significant difference in pain in these two groups in the early postoperative period (p&lt;0.001). In three-port group, the requirement of analgesic drug was significantly less as compared to four-port group (2.86±0.98 versus 3.22±0.87; p&lt;0.001). There was no statistically significant difference in the mean operating time, duration of hospital stay, intra and postoperative complications, days to return to normal activity, satisfaction score and conversion rate (p=0.087, p=0.061, p=0.578, p=0.555, p=0.572 and p=0.145, respectively). Conclusion: Three-port LC is a feasible, effective and safe technique that further enhances the surgical outcome in terms of postoperative pain, fewer needs for analgesic medication.

THE FIRST RESULTS OF A MINI-LAPAROSCOPIC CHOLECYSTECTOMY USING THE FAST-TRACK PROTOCOL

Summary. The aim of the study is to analyze the first results of mini-laparoscopic cholecystectomy in acute and chronic calculouscholecystitis using the fast-track protocol. The study included women aged 20 to 50 years with a body mass index of 18 to 35 kg/m2, whom the cosmetic effect of the operation was important, and quick rehabilitation times. The average age of the patients was 38 years (from 33 to 48 years). The average body mass index was 24.2 kg/m2 (from 19.0 to 30.1 kg/m2). The patient was divided into 2 groups. The main group consisted of 9 women who underwent mini-laparoscopic cholecystectomy, including 2 cases of acute calculouscholecystitis, with using the fast-track protocol. The control group consisted of 7 women who underwent the traditional laparoscopic cholecystectomy using a standard protocol for post-operative management.

Does obesity influence the results in Transvaginal Hybrid-NOTES cholecystectomy?

Morbidly obese patients are usually excluded from studies that compare Transvaginal Hybrid-NOTES Cholecystectomy (TVC) with traditional laparoscopic cholecystectomy. Therefore, these study results cannot necessarily be transferred to this group of patients. In this study, we have analyzed and compared the outcomes of the procedure with obese and non-obese patients. Data from a prospectively maintained database were retrospectively analyzed. All the TVCs performed in our clinic since 2008 were divided into groups according to their body mass index (BMI). Within these groups, we evaluated the following outcome parameters: age, ASA classification, procedural time, number of percutaneous trocars, intra- and postoperative complications, and postoperative hospital stay. Additionally, the posthospital surgical and gynecological follow-up was evaluated for additional complications and patients with class III obesity were contacted to determine further parameters. Six underweight, 76 normal weight, 72 overweight, 48 class I obesity, 15 class II obesity, and 20 class III obesity patients were analyzed. ASA classification (P < 0.001), procedural time (P < 0.001), and number of percutaneous trocars (P < 0.001) significantly increased with the BMI. By contrast, intra- and postoperative complications (P = 0.134 and P = 0.571), as well as postoperative hospital stay (P = 0.076) did not depend on the BMI. Neither did the classification according to Clavien/Dindo show a significant relation (P = 0.640). Lethality was zero. All posthospital gynecological follow-ups were inconspicuous. Telephone follow-up of class III obesity patients reached a rate of 85% after median 3.4years. There were no additional complications or problems during sexual intercourse. The satisfaction with the cosmetic and the overall result was very high. Although the results of existing studies including normal-weight or merely moderately obese patients can hardly be applied to morbidly obese patients, especially regarding procedural time and the number of percutaneous trocars, obesity should not be an exclusion criterion for TVC, regardless of its magnitude.

Single-Incision Laparoscopic Cholecystectomy Versus Traditional Laparoscopic Cholecystectomy: A updated Meta-analysis of Randomized Controlled Trials

<span style=font-size:11.0pt;mso-fareast-font-family: times= new= roman;mso-bidi-font-family:times= roman;color:windowtext=>1. Abstract <span style=font-size:10.0pt;mso-bidi-font-family: times= new= roman;color:windowtext=> 1.1. Objectives: To assess the clinical efficacy of Single-Incision Laparoscopic Cholecystectomy <span style=font-size:10.0pt;mso-bidi-font-family: times= new= roman;color:windowtext;letter-spacing:0pt;mso-font-kerning:0pt=> (LESS) compared with Traditional Laparoscopic Cholecystectomy (TLC) based on published literature. 1.2. Subjects and Methods: An online systematic search Randomized Controlled Trials (RCTs) comparing LESS with TLC were included Pubmed, Embase and the Cochrane Library. The inclusion and extraction of the data were completed by two authors independently. Meta-analysis was performed using version Review Manager 5.1.4 software. The clinical outcomes measures were demographics, postoperative Visual Analog Scale pain score, operative complication rate, intraoperative blood loss, cosmetic score, postoperative hospital stay, operating time, wound length; operating time, quality of life score was evaluated by Odds Ratio (OR) and Standard Mean Difference (SMD) according to the different types of data. A meta-analysis of the outcomes was conducted. 1.3. Results: Fifteen RCTs involving 1069 patients met the predefined inclusion criteria. The cosmetic score of the LESS group was statistically higher than that for TLC. (SMD, 0.55; 95 % CI, 0.20, 0.90; p = 0.002); the postoperative hospital stay of the LESS group was statistically shorter than that for TLC. (SMD, -0.24; 95 % CI, -0.44, -0.04; p = 0.02); the operating time of LESS groups was statistically longer than TLC. (SMD, 0.83; 95 % CI, 0.52, 1.14; p < 0.00001); the wound length of LESS was statistically smaller than TLC. (SMD, -2.90; 95 % CI, - 4.22, -1.58; p < 0.0001); the quality of life of LESS was statistically better than that for TLC. (SMD, 1.17; 95 % CI, 0.06, 2.28; p =0.04); There was no significant difference between the two groups with Visual Analog Scale pain score, intraoperative blood loss, perioperative complication rate. 1.4. Conclusion: LESS is associated with a higher cosmetic score, shorter postoperative hospital stays, smaller wound length, better short-term quality of life compared with TLC. 2. Keywords: <span style=font-size:11.0pt;mso-bidi-font-family: times= new= roman;color:windowtext=> <span style=font-size:10.0pt; mso-bidi-font-family: times= new= roman;color:windowtext=>Laparoscopic Cholecystectomy; Meta-Analysis; Single-Incision; Traditional Laparoscopic Cholecystectomy

Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared with Traditional Laparoscopic Cholecystectomy: Erratum

Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared with Traditional Laparoscopic Cholecystectomy: Erratum

Three-Port, Two Located on the Pfannenstiel Line, Laparoscopic Cholecystectomy Comparison with Traditional Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) is seen as a gateway to minimally invasive surgery. We defined a new three-port technique with different port sites and compared the postoperative results with traditional four-port LC procedure in a case-match study. Between June 2012 and May 2013, 104 consecutive patients underwent three-port LC by same experienced surgeon. In the same center, 2963 consecutive patients underwent four-port LC, and of these 2963 patients, a matched group of 104 patients was selected. Data included patient age, gender, body mass index, American Society of Anesthesiologists score, history of abdominal operations, intraoperative data about operating time and conversion to open surgery, and postoperative data about length of hospital stay and postoperative complications were recorded prospectively. We concluded that our new three-port technique with different port sites is as feasible and safe as traditional four-port technique.

An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery

BackgroundThe performance of laparoscopic cholecystectomy could be a technical challenge. Procedure success depends on multiple factors namely: hepatobiliary anatomical variations, pathologic changes in the gallbladder and surrounding tissues, pre-operative interventional attempts, the individual surgeon’s skill and finally patient co-morbidities. Anticipating the attendant challenges, can help to avoid several known complications associated with this procedure. Searching a more reliable anatomical topography to adopt during laparoscopic cholecystectomy is the basis for a safe surgical technique. MethodsBetween January 2012 and August 2015, 525 cases were presented with acute cholecystitis. Patients were classified in to two groups regarding degree of dissection difficulty. The study concept is defined and applied by the author in all study cases. No single case was excluded from the study. ResultsResults are processed in comparative way between both groups of the study. The increased risk results in Group B are related to technical difficulties. ConclusionThe study has offered a novel anatomical concept and safe surgical technique avoiding exploration of Calot’s triangle. The new concept has minimized dissection demands and risk of injury related to the traditional laparoscopic cholecystectomy. The study has proposed a potentially secure and empirical laparoscopic cholecystectomy technique that could be considered in every case.