Anatomical Footprint for Safe Laparoscopic Cholecystectomy Without Using Any Energy Source: a Modified Technique

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2007 May 5

PMID 17479331

Citations 15

Authors

B B Agarwal

Brij Agarwal

Manish Gupta

Sneh Agarwal

Krishan Mahajan

Affiliations

Soon will be listed here.

Abstract

Background: Over the last two decades, laparoscopic cholecystectomy has become the gold standard for treating cholecystolithiasis and an index operation for evaluation and assessment of laparoscopic surgical skills. Its wider application and continuous refinement have not been accompanied by a commensurate decrease in morbidity due to biliary, vascular, or visceral injuries. Use of an energy source, especially monopolar electrosurgery, has been identified as a culprit for many of these injuries. This study assessed the feasibility of performing laparoscopic cholecystectomy safely without using any energy source by taking advantage of the avascular anatomical planes.

Method: Patients attending the surgery clinic of our center who were candidates for a laparoscopic cholecystectomy were enrolled. Informed consent was obtained from each patient before the procedure. The study was approved by the Ethical Review Board of the hospital and was conducted as per GCP guidelines.

Results: Between June 2005 and July 2006, 83 patients were enrolled. All patients underwent laparoscopic cholecystectomy without any energy source being used. There was no incidence of biliary, vascular, or visceral injury. All patients remained hemodynamically stable. There was no conversion or mortality. The hospital stay was 8-16 h. Patients were followed up by telephone for the first 48 hours and then by regular outpatient visits until they were well.

Conclusion: A safe laparoscopic cholecystectomy without using any energy source can be performed by following the proper anatomical footprint.

Citing Articles

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References

Sietses C, Eijsbouts QAJ , von Blomberg B, Cuesta M . Ultrasonic energy vs monopolar electrosurgery in laparoscopic cholecystectomy: influence on the postoperative systemic immune response. Surg Endosc. 2001; 15(1):69-71. DOI: 10.1007/s004640010061. View

Izuishi K, Toyama Y, Nakano S, Goda F, Usuki H, Masaki T . Preoperative assessment of the aberrant bile duct using multislice computed tomography cholangiography. Am J Surg. 2005; 189(1):53-5. DOI: 10.1016/j.amjsurg.2004.06.039. View

Schmidt S, Langrehr J, Hintze R, Neuhaus P . Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg. 2004; 92(1):76-82. DOI: 10.1002/bjs.4775. View

Voorhees J, Cohen-Gadol A, Laws E, Spencer D . Battling blood loss in neurosurgery: Harvey Cushing's embrace of electrosurgery. J Neurosurg. 2005; 102(4):745-52. DOI: 10.3171/jns.2005.102.4.0745. View

Meakins J . Evidence-based surgery. Surg Clin North Am. 2006; 86(1):1-16, vii. DOI: 10.1016/j.suc.2005.10.004. View

Aggarwal R, Moorthy K, Darzi A . Laparoscopic skills training and assessment. Br J Surg. 2004; 91(12):1549-58. DOI: 10.1002/bjs.4816. View

Tang B, Hanna G, Carter F, Adamson G, Martindale J, Cuschieri A . Competence assessment of laparoscopic operative and cognitive skills: Objective Structured Clinical Examination (OSCE) or Observational Clinical Human Reliability Assessment (OCHRA). World J Surg. 2006; 30(4):527-34. DOI: 10.1007/s00268-005-0157-z. View

Tang B, Hanna G, Joice P, Cuschieri A . Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg. 2004; 139(11):1215-20. DOI: 10.1001/archsurg.139.11.1215. View

Lee K, Shan Y, Wang S, Lin P . Verres needle decompression of distended gallbladder to facilitate laparoscopic cholecystectomy in acute cholecystitis: a prospective study. Hepatogastroenterology. 2005; 52(65):1388-92. View

10.

Hugh T . New strategies to prevent laparoscopic bile duct injury--surgeons can learn from pilots. Surgery. 2002; 132(5):826-35. DOI: 10.1067/msy.2002.127681. View

11.

Barrat C, Capelluto E, Champault G . Intraperitoneal thermal variations during laparoscopic surgery. Surg Endosc. 1999; 13(2):136-8. DOI: 10.1007/s004649900922. View

12.

Tebala G . Three-port laparoscopic cholecystectomy by harmonic dissection without cystic duct and artery clipping. Am J Surg. 2006; 191(5):718-20. DOI: 10.1016/j.amjsurg.2005.07.029. View

13.

Kern K . Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences. Arch Surg. 1997; 132(4):392-7; discussion 397-8. DOI: 10.1001/archsurg.1997.01430280066009. View

14.

Tucker R . Laparoscopic electrosurgical injuries: survey results and their implications. Surg Laparosc Endosc. 1995; 5(4):311-7. View

15.

Yau H, Lee K, Kao E, Chuang H, Chou S, Huang M . Color Doppler ultrasound detection and classification of the tangential hepatic vein before laparoscopic cholecystectomy. Surg Endosc. 2005; 19(10):1377-80. DOI: 10.1007/s00464-004-2251-y. View

16.

Connor S, Garden O . Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006; 93(2):158-68. DOI: 10.1002/bjs.5266. View

17.

Gray S . Knowledge management: a core skill for surgeons who manage. Surg Clin North Am. 2006; 86(1):17-39, vii-viii. DOI: 10.1016/j.suc.2005.11.004. View

18.

Stiles B, Adusumilli P, Bhargava A, Fong Y . Fluorescent cholangiography in a mouse model: an innovative method for improved laparoscopic identification of the biliary anatomy. Surg Endosc. 2006; 20(8):1291-5. DOI: 10.1007/s00464-005-0664-x. View

19.

Shen B, Li H, Chen M, Zheng M, Zang L, Jiang S . Color Doppler ultrasonographic assessment of the risk of injury to major branch of the middle hepatic vein during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int. 2003; 2(1):126-30. View

20.

Diamond T, Mole D . Anatomical orientation and cross-checking-the key to safer laparoscopic cholecystectomy. Br J Surg. 2005; 92(6):663-4. DOI: 10.1002/bjs.4992. View