Use Of Retrieval Bag Research Articles

Evidence-based surgery for laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy is frequently performed for acute cholecystitis and symptomatic cholelithiasis. Considerable variation in the execution of key steps of the operation remains. We conducted a systematic review of evidence regarding best practices for critical intraoperative steps for laparoscopic cholecystectomy. MethodsWe identified 5 main intraoperative decision points in laparoscopic cholecystectomy: (1) number and position of laparoscopic ports; (2) identification of cystic artery and duct; (3) division of cystic artery and duct; (4) indications for subtotal cholecystectomy; and (5) retrieval of the gallbladder. PubMed, EMBASE, and Web of Science were queried for relevant studies. Randomized controlled trials and systematic reviews were included for analysis, and evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework. ResultsFifty-two articles were included. Although all port configurations were comparable from a safety standpoint, fewer ports sometimes resulted in improved cosmesis or decreased pain but longer operative times. The critical view of safety should be obtained for identification of the cystic duct and artery but may be obtained through fundus-first dissection and augmented with cholangiography or ultrasound. Insufficient evidence exists to compare harmonic-shear, clipless ligation against clip ligation of the cystic duct and artery. Stump closure during subtotal cholecystectomy may reduce rates of bile leak and reoperation. Use of retrieval bag for gallbladder extraction results in minimal benefit. Most studies were underpowered to detect differences in incidence of rare complications. ConclusionKey operative steps of laparoscopic cholecystectomy should be informed by both compiled data and surgeon preference/patient considerations.

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Use of retrieval bag using drain bag vs direct extraction of gall bladder specimen after laparoscopic cholecystectomy: Our experience with 600 patients

Use of retrieval bag using drain bag vs direct extraction of gall bladder specimen after laparoscopic cholecystectomy: Our experience with 600 patients

Laparoscopic myomectomy using self-made retrieval bag to contain tissue extraction

To introduce an effective approach using a self-made retrieval bag during laparoscopic myomectomy to contain tissue extraction. Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. University hospital. A 32-year-old woman diagnosed with a uterine myoma (diameter, 6 cm). She had endured 5 years of intermittent lower abdominal pain and 2 years of infertility. A self-made retrieval bag during laparoscopic myomectomy was used (consists of four steps) to contain tissue extraction. 1. Self-made retrieval bag using a sterile medical bag. 2. Inspect the pelvic cavity, evaluate and determine the location and number of myomas. 3. Resect the myoma. 4. Morcellate the myoma into pieces inside the retrieval bag using laparoscopic power morcellation. Value and feasibility of using a self-made retrieval bag in laparoscopic myomectomy. The myoma was successfully and completely resected by laparoscopy using a self-made retrieval bag to contain tissue extraction. Operative time was 93 minutes. In the follow-up period, the patient did not report any symptom of iatrogenic parasitic myoma. The woman had a pregnancy at month 26 after operation and underwent a cesarean section. This resulted in a full-term baby. Our surgical approach demonstrated a number of noteworthy advantages. The use of retrieval bag to contain tissue extraction during laparoscopic morcellation can avoid the risk of iatrogenic parasitic myoma. The retrieval bag is self-made using a sterile packing bag, which is cost free and also reduces operative expenses.

Frequency of port site wound infection after Gall Bladder removal with or without retrieval bag in Laparoscopic Cholecystectomy.

The rationale of the study was to depict the safest method of extracting gallbladder after laparoscopic cholecystectomy to decrease the frequency of wound infection. The objective of the study was to compare the frequency of port site wound infection after gallbladder removal with or without retrieval bag in laparoscopic cholecystectomy. The study design was Randomized Parallel group design conductedin the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur. A total of 254 patients of both gender age range 25-60 years, diagnosed as a case of cholelithiasis by ultrasonography were included. Case sheet of patients were prepared for age, gender, duration of cholelithiasis, operating time and presence or absence of wound infection. Mean age of patients was 40.77 ± 10.95 years. Out of 254 patients, 98 (38.58%) were males and 156 (61.42%) were females with male to female ratio of 1:2.5. Patients were divided in two groups A and B and the frequency of patients having port site wound infection in group A was 1(0.4%) whereas in group B was 14(5.5%). This study concluded that the use of retrieval bag to remove gallbladder in laparoscopic cholecystectomy resulted in decreased frequency of port site wound infection. The insignificant association of port site wound infection with different age groups, gender categories and with duration of cholelithiasis was revealed. Moreover wound infection proved significantly associated with both categories with operating time.

BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA.

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim:To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions:It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis

BackgroundSurgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections.MethodsInclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were (“gallbladder”AND(“speciment”OR“extraction”OR“extract”))OR(“gallbladder”OR“cholecystectomy”)AND(“bag”OR“retrieval|”OR|“endobag”OR“endocatch”).ResultsThe comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41–1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern.ConclusionsThe results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed.

Precise Preoperative Imaging and Adequate Oncologic Resection is Most Important in Achieving Long‐Term Prognosis in Gallbladder Cancer

We read with interest the article by Goetze and Paolucci entitled, ‘‘Use of Retrieval Bags in Incidental Gallbladder Cancer Cases’’ [1]. It reports on a multicenter study that included approximately 600 patients suffering from occult gallbladder cancer. This analysis is of substantial importance, particularly regarding the high frequency of laparoscopic cholecystectomies. With high esteem, nevertheless allow us to supply some annotations and additions. The primary goal of surgical treatment of gallbladder cancer must be the oncologic adequate resection to avoid local or general recurrence [2]. The elevated rate of trocar metastasis and peritoneal seeding, local recurrence, and distant metastasis (together 27.2 vs 38.4%) in case of intraoperative perforation during minimal invasive cholecystectomy of the gallbladder is an impressive observation. However, the meaning for overall long-term prognosis has not been analyzed and remains unclear. From our point of view, a primary open access is mandatory in any case of preoperative suspicion of malignancy (ultrasound, CT). Only a few exceptions can be made: e.g., when peritoneal carcinosis has to be counted out. In case of intraoperative suspicion, immediate or secondary conversion from minimal to open access has to be performed [3]. When gallbladder cancer is detected in the specimen after laparoscopic cholecystectomy, an oncologic adequate, open re-resection (including trocar channels) has to be performed from stage T1b on. The extension depends on the TNM stage of the disease, including lymphadenectomy and most often—even extended—liver resection. Fong et al. [4] point out the high value of aggressive re-resection for postoperatively diagnosed gallbladder cancer of all stages. They support other authors who describe no difference in long-term prognosis between patients with a primary open resection and patients who received a minimal invasive cholecystectomy followed by an open re-resection. Limiting therapy to an exclusively minimal open access is not oncologically justified in case of highly malignant gallbladder cancer (T1b or higher) [5–7]. For this reason, intraoperative suspicion of malignancy must not only cause using a retrieval bag but also be the cause for immediate or secondary conversion to open access. In the published study, we cannot extract any information about whether re-resection and what kind of reresection was performed to prevent tumor recurrence, despite that it was an item in the questionnaires. Very impressively Goetze and Paolucci showed the significantly worsened relapse rate in case of gallbladder perforation: 38.4 vs 27.2% without perforation. The usage of a retrieval bag caused no further difference in local recurrence rate but did so for the rate of trocar metastases. Concerning interpretation the question arises whether both the decision to use a retrieval bag and the event of an intraoperative perforation cannot be an expression of difficult conditions for cholecystectomy. These difficult conditions might be secondary to a more advanced tumor stage (joining cholecystitis, infiltration of neighboring tissue/ organs). Therefore, it might be that not the perforation or the use of a bag itself is the decisive factor for the worsened or improved prognosis. The observation that 30 of 174 carcinomas extracted laparoscopically by using a retrieval bag have been T3 carcinomas (additionally that of 330 laparoscopic operated incidental carcinomas 187 cases have been T2, 44 cases of U. K. Fetzner (&) K. L. Prenzel H. Alakus A. H. Holscher D. L. Stippel Department of General-, Visceraland Cancer Surgery, University of Cologne, Cologne, Germany e-mail: ulrich.fetzner@uk-koeln.de

Use of Retrieval Bags in Incidental Gallbladder Cancer Cases

Accidental intraoperative gallbladder perforation is a problem in laparoscopic surgery, especially in cases with incidental gallbladder carcinoma (IGBC). The question is whether intraoperative gallbladder perforation has a prognostic disadvantage or a retrieval bag provides protection against tumor dissemination. A standardized questionnaire was sent to all German surgical clinics based on the central register of "incidental gallbladder carcinoma" of the German Society of Surgery founded in 1997. In 592 IGBC-registered cases, there were 330 laparoscopies, 154 open surgeries, and intraoperative conversion was performed in 106 cases. Of laparoscopic surgeries (n = 330), the recurrence rate was 30%. The recurrence rate for cases with (174/330) and without (156/330) the use of retrieval bag was 32.2% and 27%, respectively. In laparoscopies with intraoperative gallbladder perforation (73/330 cases), the recurrence rate was 38.4%. Of these cases the recurrence rate with (51/73) and without (22/73) the use of retrieval bags was 39.2% and 36.4%, respectively. In 257 cases without intraoperative perforation, tumor recurrence rate was 27.2%, and it was 29.3% or 25.4% with (123/257) and without (134/257) the use of retrieval bags. According to the registry data, the intraoperative gallbladder perforation results in significant (P = 0.047) prognostic disadvantage and in these cases retrieval bags were used more often (P = 0.001). However, in IGBC cases if intraoperative gallbladder perforation has already happened, the use of retrieval bags had no protective effects.

Incidental carcinoma gall bladder during laparoscopic cholecystectomy for symptomatic gall stone disease

Carcinoma gall bladder (CaGB) is a disease with high mortality and is usually diagnosed as an incidental case among patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gall stone disease. A total of 3205 LC done between January 2004 and August 2007 for symptomatic gall stone disease were retrospectively searched for incidental CaGB (detected on histopathology). None of these cases had preoperative suspicion of malignancy and their whole data was analyzed with special attention to preoperative and intraoperative findings which could raise suspicion of CaGB. In November 2007, patients were followed up telephonically about their present status of health. Nineteen patients (14 female and 5 male) with incidental CaGB (incidence 0.59%) were detected. Mean age of the patients was 56 years. Only two of these patients had clinical jaundice and both had common bile duct (CBD) stones. The majority of the patients were in early pathological stages (pT) and none was in pT3 and pT4 stage. Seventeen patients could be followed up telephonically in November 2007 and of those 14 patients were alive at a mean follow-up duration of 21.2 months, with one of them having evidence of metastatic disease. Gall bladder (GB) malignancy may be curable if diagnosed in early stages as an incidental finding and LC may not worsen the prognosis in such cases. In our series, incidental CaGB was detected in 0.59% patients undergoing LC. No association could be found between preoperative and intraoperative findings that could raise a suspicion of malignancy of gall bladder and so use of retrieval bag as a routine measure in cases with bile spillage may reduce the incidence of port-site metastasis.

Fisherman's Technique, Introducing a Novel Method for Using the Umbilical Port for Removal of Appendix During Laparoscopic Appendectomy

We describe a useful technique for removing the dissected appendix after laparoscopic appendectomy. This technique allows laparoscopic appendectomy to be completed with a single 10-mm and two 5-mm ports using only one 10-mm telescope. In this technique the dissected appendix is tied with an endoloop and then the end of this loop is railroaded through the umbilical port that will allow the appendix to be pulled (or fished) through the umbilical port. The advantage of this technique over older techniques is that it uses the full width of the 10 mm port, which makes it suitable for almost all cases with no chance of appendicular fragmentation during retrieval. The technique is safe, inexpensive, and does not need the use of retrieval bags.

Port site tuberculosis following laparoscopic cholecystectomy

Port site metastasis is being increasingly reported as a complication following laparoscopic surgery for malignant disorders. Various factors have been reported to be responsible and most are associated with either a high intra-peritoneal pressure due to pneumoperitoneum or the 'chimney effect' following sudden decompression of the abdomen. Direct implantation of the offending cells at the raw surface at the port has also been implicated and the use of retrieval bags is therefore recommended. We report on a rare case of port site seeding of tuberculosis in a 65-year-old woman following laparoscopic cholecystectomy.

Recognizing the hazards of mechanical morcellation with use of retrieval bags

Recognizing the hazards of mechanical morcellation with use of retrieval bags