Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CHOLECYSTECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,063 records · Page 59Linked to original sources
PubMed2002

Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status.

BACKGROUND: Laparoscopic cholecystectomy is frequently an ambulatory procedure, but some patients are best admitted for a brief hospital stay. In this study, we compared the functional health status, symptoms, and outcomes of patients undergoing ambulatory elective laparoscopic cholecystectomy to those with brief hospital admission. The purpose was to assess patient satisfaction and to identify factors that might assist in selecting patients for ambulatory vs short-stay operations. METHODS: A total of 140 patients scheduled for elective cholecystectomy completed the SF-36 health survey and provided additional information regarding symptoms preoperatively, at 2 months, and at 6 months after operation. RESULTS: All patients had symptomatic gallstones; 76 were admitted to the hospital, and 64 were ambulatory. Admitted patients reported more emotional role limitations on preoperative SF-36. They also reported symptoms of depression more often. Patients in both groups were equally relieved of symptoms of pain, nausea, vomiting, and tenderness. Satisfaction with care was similar for both groups; however, at 2 and 6 months, admitted patients continued to report significantly poorer functional health status than ambulatory patients. CONCLUSION: A reliable, reproducible measure of functional health status, such as the SF-36, may be useful for identifying patients who are appropriate for short-stay hospital admission after laparoscopic cholecystectomy as part of a decision process that tries to optimize outcomes while utilizing resources efficiently.

Ambulatory Care↗
PubMed2001

Systemic acute-phase response after laparoscopic and open cholecystectomy.

BACKGROUND: Cytokines are the main mediators of inflammation and the response to trauma. The purpose of this study was to compare variations in cytokine levels following laparoscopic cholecystectomy (LC) and mini-laparotomy cholecystectomy (OC), since these two types of operations were considered to be a unique model for examining the role of local tissue injury in postoperative inflammatory reactions. METHODS: A total of 40 patients were studied. Eighteen of them underwent LC; the remaining 22 were operated on using the open technique. Systemic concentrations of interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured before and after the operation. In addition, we compared pre- and postoperative white blood cell (WBC) counts, postoperative body temperature, and length of postoperative hospitalization. RESULTS: There was no difference between the two groups in IL-1 and TNF response. The rise in plasma IL-6 levels (18.86 +/- 9.61 vs 5.00 +/- 0.0 pg/ml, p < 0.0001) and CRP (8.40 +/- 5.81 vs 1.43 +/- 1.30 mg/dl, p < 0.001) were more marked after open cholecystectomy than after the laparoscopic procedure. There was no correlation between serum CRP concentrations and the other postoperative parameters. CONCLUSION: The magnitude of the acute-phase response was less pronounced following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.

Acute-Phase Reaction↗
PubMed2001

Fundus-first laparoscopic cholecystectomy.

BACKGROUND: Fundus-first dissection (FFD) is an established technique to deal with difficult open cholecystectomies. Although the indications for such an approach are similar for laparoscopic cholecystectomy (LC), FFD is not widely practiced because of difficulties that arise with liver retraction, the dissection of dense adhesions, or obscured cystic pedicles, often necessitating conversion to an open procedure. METHODS: The aim of this study was to evaluate the indications for FFD and the technical aspects of the procedure in cases with a difficult cystic pedicle. Prospectively collected data and video recordings of cases of fundus-first laparoscopic cholecystectomy (FFLC) were analyzed. The great majority were difficult cases, so we also reviewed the safety aspects of this approach and assessed its effect on the conversion rate. RESULTS: FFLC was resorted to in 35 cases (5%) of 710 consecutive LCs with difficulty grade II (two cases), III (13 cases), or IV (20 cases). There were 16 male patients (46% vs 9% males in the whole), and the mean age was 56 years (ranges, 28-87). The reasons for FFD were dense adhesions preventing the exposure of the cystic pedicle in 14 cases, large Hartmann's pouch stones in 10 cases, short dilated cystic ducts in six cases, and Mirizzi syndrome in three cases. Two cases had contracted "burn-out" gallbladders. Intraoperative cholangiography (IOC) was possible in 24 patients, failed in 10 (29%), and was not attemped in one. Seven patients had bile duct stones and required bile duct exploration. FFLC was completed in 31 patients, 28 of whom were seriously considered for conversion prior to commencing FFD. Conversion was still necessary after trial FFD in four cases (11%) two with Mirizzi abnormalities, one with bile duct stones, and one with dense adhesions. The mean operative time was 125 min, (range, 50-230). There were no operative or technique-related complications. CONCLUSION: FFLC is feasible and is a safe option for cases with a difficult cystic pedicle. Its use reduced the conversion rate of the series from a potential 5.2% to 1.2%, However, subtotal cholecystectomy or conversion must not be delayed if, after the neck of the gallbladder is reached the anatomy is still unclear.

Adult↗
PubMed2002

The duration of hemodynamic depression during laparoscopic cholecystectomy.

BACKGROUND: We previously evaluated the effects of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy and found that patient position had no effect on cardiac index (CI), stroke volume (SV), and left ventricular end diastolic volume (LVEDV). Analysis of that data showed that the hemodynamic depression associated with pneumoperitoneum was transient with values trending toward baseline during the operative period. The purpose of this study was to examine the duration of the adverse hemodynamic effects of pneumoperitoneum during laparoscopic cholecystectomy. METHODS: Thirty-eight patients undergoing laparoscopic cholecystectomy by a single surgeon were enrolled in the study. Hemodynamic data was collected via a transthoracic bioimpedance monitor. Baseline readings were taken prior to establishing pneumoperitoneum. Data was then collected continuously over the course of each case. Patients were compared to their baseline values. Data was analyzed every 5 min with the paired t-test used to determine statistical significance. RESULTS: All parameters were compared to baseline values. Baseline was defined as 5 min after the induction of anesthesia. With insufflation to 15 mmHg CO2, CI fell from a baseline value of 2.82 L/min/m2 to 2.66 L/min/m2 (p = 0.04), SV from 71.58 mL to 65.44 mL (p = 0.002), and LVEDV from 111.46 mL to 102.68 mL (p = 0.003). At 5 min, all values were further depressed. At 10 min all values were no longer significantly different from baseline. Values returned to baseline at 15 min and did not walver for the remainder of each case or the next 35 min. CONCLUSION: Patients undergoing laparoscopic cholecystectomy experience significant hemodynamic depression with pneumoperitoneum. These changes are short-lived and lose their statistical significance at 10 min from the time a patient undergoes pneumoperitoneum.

Cholecystectomy, Laparoscopic↗
PubMed2003

Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery.

BACKGROUND: Previous abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. This study specifically examined the effect of previous intraabdominal surgery on the feasibility and safety of laparoscopic cholecystectomy. METHODS: Data from 1,638 consecutive patients who underwent laparoscopic cholecystectomy were reviewed and analyzed for open conversion rates, operative times, intra- and postoperative complications, and hospital stay. RESULTS: Of the 1,638 study patients 473 (28.9%) had undergone previous abdominal surgery: 58 upper and 415 lower abdominal operations. The 262 patients who had undergone only a previous appendectomy were excluded from further analysis. Adhesions were found in 70.7%, 58.8% and 2.1% of patients respectively, who had previous upper, lower or no previous abdominal surgery with adhesiolysis required, respectively, in 78%, 30% and 0% of these cases. There were no complications directly attributable to adhesiolysis. Patients with previous upper abdominal surgery had a longer operating time (66.4 +/- 34.2 min), a higher open conversion rate (19%), a higher incidence of postoperative wound infection (5.2%), and a longer postoperative stay (3.4 +/- 2.1 days) than those who had undergone previous lower abdominal surgery (50.8 +/- 24 min, 3.3%, 0.7%, and 2.6 +/- 1.4 days, respectively) and those without prior abdominal surgery (47.4 +/- 25.6 min, 5.4%, 1.2%, and 2.8 +/- 1.9 days, respectively). CONCLUSIONS: Previous abdominal operations, even in the upper abdomen, are not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a higher open conversion rate, a prolonged operating time, an increased incidence of postoperative wound infection, and a longer postoperative stay.

Abdomen↗
PubMed2005

Correlating motor performance with surgical error in laparoscopic cholecystectomy.

BACKGROUND: Analysis of motor performance in minimally invasive surgery (MIS) is a new field with applications in surgical training, surgical simulators, and robotics. Force/torque and derivatives of tool tip position (velocity, acceleration, and jerk) are examples of measures of motor performance (MMPs). Few studies have measured MMPs or have correlated MMPs with surgical performance during MIS on humans. The objectives of this study were to determine the feasibility of a novel multimodal system to quantify MMPs in laparoscopic cholecystectomy and to attempt to correlate MMPs with the magnitude of error as a measure of surgical performance. METHODS: Novice and expert surgeons performed laparoscopic cholecystectomies in two groups of three patients each. MMPs were obtained using a combination of optical and electromagnetic tool tip tracking and a force/torque sensor on a modified Maryland dissector. Error scores for laparoscopic cholecystectomy were calculated using a previously validated system. Novice and expert measurements were compared, and correlations were made between error scores and MMPs. RESULTS: Error scores were similar between novices and experts. Novice surgeons had a significantly greater mean velocity (566 +/- 83 vs 85 +/- 32 mm/s, p = 0.006) and acceleration (2,600 +/- 760 vs 440 +/- 174 mm/s2, p = 0.050) compared to expert surgeons. Force (16.5 +/- 4.6 vs 18.3 +/- 6.0 N, p = 0.829), position (121 +/- 25 vs 135 +/- 72 mm, p = 0.863), and jerk (19,600 +/- 7,410 vs 2,430 +/- 367 mm/s3, p = 0.138) were similar between groups. A positive correlation was found in novice surgeons between error score and jerk (Pearson correlation, 0.999; p = 0.035). CONCLUSIONS: It is feasible to quantify MMPs in laparoscopic cholecystectomy. Novice and expert surgeons can be differentiated by MMPs; moreover, there may be a positive correlation between jerk and error score in novice surgeons.

Adult↗
PubMed2006

Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy.

The incidence of bile duct injury in laparoscopic cholecystectomy is 0.3% to 1.0%. This is higher than the incidence reported for open cholecystectomy (i.e., 0.1-0.2%), and the surgeons all over the world are relentlessly trying to find the ways and means to lower this incidence. Various operating strategies, techniques, and instrumentations such as the 0 degrees telescope, intraoperative cholangiogram, hydrodissection, and peanut gauze dissection have been claimed by various authors to minimize the risk of bile duct injury during cholecystectomy. However, the surgical fraternity agrees that there has been no substitute for meticulous dissection and display of various vital structures near the common bile duct. The authors describe seven anatomic landmarks encountered during laparoscopic cholecystectomy that assist in safe dissection to prevent bile duct and vascular injury. On the basis of their experience, they believe that if surgeons adhere to these landmarks, excellent results can be achieved.

Adult↗
PubMed2006

Mirizzi syndrome: laparoscopic management by subtotal cholecystectomy.

BACKGROUND: The authors present their experience with laparoscopic subtotal cholecystectomy for the management of Mirizzi's syndrome and their review of the literature. METHODS: Over a period of 24 months, five cases of Mirizzi's syndrome were encountered, representing 1.5% of all the laparoscopic cholecystectomies performed in the authors' unit. The sex ratio was 4 females to 1 male, and the mean age of the patients was 66 years. All underwent a subtotal cholecystectomy. RESULTS: All procedures were completed laparoscopically. Morbidities involved one case of biliary peritonitis and a one case of biliary leak requiring endoscopic stenting. CONCLUSION: Mirizzi's syndrome cannot always be anticipated on the basis of preoperative staging, and often is encountered during the procedure. The "anatomic scenario" of this condition should be suspected for patients presenting with conditions such as empyema or mucocoele when there is a likelihood of stone impaction in the infundibulum of the gallbladder. Subtotal cholecystectomy with secure intraperitoneal biliary drainage appears to be a safe option for these patients.

Adult↗
PubMed2006

A nontransfusional perioperative management regimen for patients with sickle cell disease undergoing laparoscopic cholecystectomy.

BACKGROUND: Patients with sickle cell disease (SCD) are at increased risk for cholelithiasis. Laparoscopic cholecystectomy is the most frequent general surgical operation performed for this group of patients. Acute chest syndrome (ACS) is the most common cause of postoperative death among SCD patients. This study aimed to evaluate the impact of a novel perioperative management regimen involving prophylactic continuous positive airways pressure (CPAP) ventilation and avoidance of preoperative blood transfusion on postoperative SCD-related complications after laparoscopic cholecystectomy. METHODS: A retrospective study included all SCD patients who underwent laparoscopic cholecystectomy since 1997 at our institution. Medical notes were analyzed to assess the rates of postoperative complications in relation to the severity of SCD. RESULTS: A total of 13 patients were identified. There were no recorded episodes of acute painful crises and only one patient experienced an episode of ACS requiring protracted CPAP. CONCLUSION: Laparoscopic cholecystectomy can be safely performed for SCD patients without prior blood transfusion. A defined perioperative regimen including the use of routine postoperative prophylactic CPAP for these patients helps to reduce SCD-related postoperative complications such as ACS and painful vaso-occlusive crises.

Adolescent↗
PubMed2001

Results and complications of laparoscopic cholecystectomy in childhood.

BACKGROUND: The purpose of our study was to evaluate the results and complications of laparoscopic cholecystectomy in a case series of 110 infants. METHODS: Over a 5-year period (1993-98), we performed laparoscopic cholecystectomy in 110 pediatric patients. Surgery was performed at different institutions by three different surgeons. The patient population was composed of 69 girls and 41 boys; their ages ranged from 1 to 16 years (median, 8.5). All of the 110 children had symptomatic cholelithiasis, which was confirmed at ultrasound examination. An associated pathology was present in 27 patients (sickle cell disease in 17 cases, hereditary spherocytosis in seven cases, thalassemia in three); the other 83 infants were affected by idiopathic cholelithiasis. In 107 patients, the operation was performed using four ports; in three patients, it was done using five ports. In three patients, we also performed a concomitant splenectomy. RESULTS: Median duration of simple cholecystectomy was 45 min (range, 25-75) and hospital stay ranged from 1 to 10 days (median, 2). Only 15 children required drainage. We had 17 complications in our series (15.5%), including a gallbladder perforation during dissection in 11 patients, a fall of stones into the abdominal cavity during extraction in one patient, and a trocar orifice infection in the postoperative period in five patients. At a maximum follow-up of five years (range, 1-5), all patients were doing well. CONCLUSION: Laparoscopic cholecystectomy in children seems to be as effective as open surgery in cases of symptomatic cholelithiasis. In pediatric patients more than in adults, an accurate and precise dissection and a sound knowledge of possible congenital biliary abnormalities are essential to avoid any kind of complication.

Adolescent↗
PubMed2000

Intraoperative cholangiography during laparoscopic cholecystectomy.

BACKGROUND: The routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy remains controversial. METHODS: A retrospective review of 950 consecutive laparoscopic cholecystectomies performed during an 8-year period was performed. For the first 2 years, IOC was performed selectively, and thereafter routinely. RESULTS: Attempted in 896 patients, IOC was successful in 734 (82%). Bile duct stones were found in 77 patients (10%), dilated ducts without stones in 47 patients (6%), and anatomic variations in 4 patients (0.5%). There were four (0.4%) minor intraoperative complications related to the IOC, with no consequences for the patients. There were three (0.3%) minor injuries of the bile duct, which were identified with IOC and repaired at the time of cholecystectomy without any consequences for the patients. In two of these patients, the structure recognized and catheterized as the cystic duct was revealed by IOC to be the bile duct. Thus IOC prevented extension to a major common bile duct (CBD) injury. CONCLUSIONS: Findings show that IOC is a safe technique. Its routine use during laparoscopic cholecystectomy may not prevent bile duct injuries, but it minimizes the extent of the injury so that it can be repaired easily without any consequences for the patient. The prevention of a major bile duct injury makes IOC cost effective.

Adolescent↗
PubMed2001

Selective use of endoscopic retrograde cholangiopancreatography to facilitate laparoscopic cholecystectomy without cholangiography. A review of 1139 consecutive cases.

BACKGROUND: The aim of this study was to show that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography. METHODS: We performed a retrospective analysis of 1139 consecutive patients (376 men and 763 women with an average age of 51.4 years) who underwent laparoscopic cholecystectomy between 1991 and 1999. In all, 227 patients (20%) were selected to undergo preoperative endoscopic retrograde cholangiopancreatography (ERCP) on the basis of four criteria for risk of stones. RESULTS: ERCP allowed us to make a diagnosis of biliary stones in 53.3% of the selected patients. Extraction of the stones was successful in 97% of the cases. In 14% of cases, ERCP was normal; in 32.7%, some useful diagnostic information was obtained. There were three complications (pancreatitis) following endoscopy (complication rate, 1.3%). Laparoscopic cholecystectomy was successful in 92% of patients. The postoperative morbidity rate was 3.2% (major complications, 0.5%). There were no deaths. During a follow-up period ranging from 3 to 97 months, six patients (0.6%) were found to have residual biliary stones. CONCLUSION: This study confirms the hypothesis that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2000

Antiemetic efficacy of prophylactic dimenhydrinate (Dramamine) vs ondansetron (Zofran): a randomized, prospective trial inpatients undergoing laparoscopic cholecystectomy.

BACKGROUND: The prophylactic administration of dimenhydrinate (Dramamine) is as effective as the use of ondansetron (Zofran) in preventing postoperative nausea and vomiting (PONV) in patients undergoing elective laparoscopic cholecystectomy. A prospective double-blind randomized study was performed in a tertiary care referral center. METHODS: For this study, 128 American Society of Anesthesiology (ASA) physical statuses I, II, and III patients were randomly assigned to receive either ondansetron 4 mg intravenously (IV) at $17 per dose (group 1) or dimenhydrinate 50 mg IV at $2.50 per dose (group 2) before induction of anesthesia. The end points evaluated were frequency of PONV, need for rescue antiemetics, need for overnight hospitalization secondary to persistent nausea and vomiting, and frequency PONV 24 h after discharge. RESULTS: Chi-square tests and student's t-test were used to determine the significance of differences among groups. Of the 128 patients enrolled in this study, 20 were excluded: 15 patients received an additional antiemetic preoperative; 4 were converted to open cholecystectomies; and 1 procedure was aborted due to carcinomatosis. Of the 108 remaining participants, 50 received ondansetron (group 1) and 58 received dimenhydrinate (group 2). Both groups were well matched for demographics including gender, ASA class, and history of motion sickness. The need for rescue antiemetics occurred in 34% of group 1 and 29% of Group 2 (p = 0.376), postoperative vomiting in 6% of group 1 and 12% of group 2 (p = 0.228), and postoperative nausea in 42% of group 1 and 34% of group 2 (p = 0.422). One group 1 patient and two group 2 patients required overnight hospitalization for persistent nausea, a difference that was not significant. Rates of PONV 24 h after discharge were similar between groups 1 and 2 (10% vs 14%, p = 0.397 and 2% vs 5%, p = 0.375, respectively). CONCLUSIONS: Prophylactic administration of dimenhydrinate is as effective as the use of ondansetron in preventing PONV in patients undergoing elective laparoscopic cholecystectomy. Dimenhydrinate is the preferred drug because it is less expensive. With more than 500, 000 laparoscopic cholecystectomies performed in the United States each year, the potential drug cost savings from the prophylactic administration of dimenhydrinate instead of ondansetron exceed $7.25 million per year.

Antiemetics↗
PubMed2001

Abdominal malignancies missed during laparoscopic cholecystectomy.

BACKGROUND: We present our experience with intra-abdominal malignancies different from gallbladder cancer not diagnosed preoperatively and undiscovered during laparoscopic cholecystectomy METHODS: This study involved retrospective analysis of 10 patients hospitalized in the Second Department of General Surgery between 1993 and 2000. In all of them, laparoscopic cholecystectomy had been performed between one week and 21 months earlier. RESULTS: Primary or metastatic neoplasms were diagnosed in five men and five women patients ages 38 to 79 years. In three patients with colorectal cancer, a radical resection was possible. Nonresectable pancreatic cancer was found in three patients. In one of two patients with gastric cancer, palliative, distal gastrectomy was performed. In a patient who had small bowel cancer with metastasis to the ovary, a radical operation was possible. In one patient, liver metastasis from lung cancer was found. CONCLUSIONS: In patients with atypical symptoms of gallbladder lithiasis, a thorough workup before laparoscopic cholecystectomy should be performed. During the laparoscopic procedure, a detailed examination of the whole peritoneal cavity is essential. In cases of prolonged convalescence after laparoscopic cholecystectomy, a source of symptoms different from cholelithiasis should be suspected.

Abdominal Neoplasms↗
PubMed2001

Time-action analysis of instrument positioners in laparoscopic cholecystectomy.

BACKGROUND: Instrument positioners can position and lock a laparoscopic instrument. This study uses time-action analysis to evaluate objectively whether IPs can substitute for a surgical assistant efficiently and safely. METHODS: In four hospitals, 78 laparoscopic cholecystectomies were randomly assisted by a surgical assistant or an instrument positioner (AESOP and PASSIST) The efficiency and safety of laparoscopic cholecystectomies were analyzed with respect to time, number and type of actions, positioning accuracy, and peroperative complications. A questionnaire evaluated the difficulties for each operation and the comfort of instrument positioner use. RESULTS: The PASSIST and AESOP were able to replace the surgical assistant during laparoscopic cholecystectomies without significantly changing either the efficiency or the safety of the operation. The questionnaire showed that the surgeons preferred to operate with an instrument positioner. CONCLUSION: This study assessed objectively that instrument positioners can substitute for a surgical assistant efficiently and safely in elective laparoscopic cholecystectomies.

Cholecystectomy, Laparoscopic↗
PubMed2000

Minimizing ports to improve laparoscopic cholecystectomy.

BACKGROUND: Minimizing the number and scope of ports used to perform laparoscopic cholecystectomy attempts to build on the improvements in postoperative pain control, rapid return to activity and work, patient satisfaction, and cosmetic result achieved by the laparoscopic method. METHODS: We studied 141 patients in two sequential studies: the first a prospective randomized trial with 41 patients, and the second an examination of the more minimal procedure in 100 patients. In the randomized trial, patients underwent laparoscopic cholecystectomy with three ports: three 5-mm ports or two 10-mm ports and one 5-mm port. The 100 patients underwent the three 5-mm port procedure. RESULTS: In the randomized trial, differences were not statistically significant. However, on the average, the group with three 5-mm ports required less medication over less time, had less postoperative pain, and took less time to return to activity than the second group with larger ports. A statistically significant difference was found in incisional pain between the smaller group (21 patients) with two 10-mm ports and one 5-mm port and the larger group (100 patients) with three 5-mm ports, whether the measure was overall incisional pain (p = 0.014) or a comparison based on specific ports (p = 0.001). The percentage of cases requiring port enlargement to remove the gallbladder was not significantly different between the groups. There were no conversions to an open procedure, no fourth trocars added, and no complications. No patient required overnight hospitalization. CONCLUSIONS: Reducing the number and size of ports in laparoscopic cholecystectomy sustains or enhances the improvements initiated by performing laparoscopic rather than open cholecystectomy. In a comparison of microlaparoscopic procedures, patients undergoing the procedure with the shorter incisions experienced significantly less pain.

Adult↗
PubMed1996

The movement of mucosal cells of the gallbladder within the peritoneal cavity during laparoscopic cholecystectomy.

BACKGROUND: Tumor dissemination to trocar sites following the removal of a gallbladder malignancy by laparoscopic cholecystectomy is well documented. The mode of transfer of malignant cells to those sites remains unclear. METHODS: The appearance and movement of gallbladder mucosal cells within the peritoneal cavity during laparoscopic cholecystectomy was prospectively studied in 15 patients. The appearance of cells on laparoscopic instruments, laparoscopic working ports, and also within a 5-microm polycarbonate filter, filtering exhaust carbon dioxide and attached to one of the main working ports, was noted. RESULTS: Four out of 15 gallbladders were perforated during cholecystectomy. Operative choledochography was performed in 11 of the 15 cases. Glandular cells were found on instruments at the end of the procedure in six cases. Cells were also found in two of the 15 polycarbonate filters and on the laparoscopic ports in two of the 15 cases. CONCLUSION: These findings suggest that cellular contamination of the peritoneal cavity is frequent during laparoscopic cholecystectomy. This may occur when the gallbladder wall is macroscopically breached or when operative choledochography is performed, or by microperforation due to the application of crushing laparoscopic graspers to the gallbladder wall. Glandular cells adhere to instruments in 40% of the operative procedures and may be the main source of dissemination of malignant cells through the peritoneal cavity.

Cholecystectomy, Laparoscopic↗
PubMed1997

Laparoscopic cholecystectomy in 1994. Results of a prospective survey conducted by SFCERO on 4,624 cases. Société Française de Chirurgie Endoscopique et Radiologie Opératoire.

BACKGROUND: In 1996, laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis. The results of this operation as published so far include data on the learning curve of the method. The aim of this study is to evaluate the results of laparoscopic cholecystectomy when performed by a large number of surgeons during the year 1994, not taking into account the beginning years in which the technique was being used. METHODS: This study has been carried out prospectively and anonymously among members of SFCERO. All the patients who underwent a cholecystectomy started laparoscopically during 1994 have been included. RESULTS: Some 4,624 cholecystectomies were performed by 150 surgeons. There were 3,310 females (42.5 +/- 19.8 years old) and 1,314 males (56.3 +/- 1.61 years old). The conversion rate was 6.9%: 320 operations had to be converted into laparotomy (group II) while 4,261 were performed entirely by laparoscopy (group I). Morbidity was 5% (N = 230)-4.7% in group I (N = 203) and 8.4% in group II (N = 27). Mortality was 0.2% (N = 9)--namely four intraabdominal complications (three cases of peritonitis and one biliary re-operation), two cardiac failures, and one brain infarction. The causes of death were not specified in two patients. CONCLUSIONS: These results show that morbidity and mortality have not changed dramatically since the beginnings of this technique, whereas the frequency of common bile duct (CBD) injuries has decreased. However, the conversion rate has increased slightly. These results make it possible to calculate the risk of conversion and postoperative complication according to the age of the patient and the biliary symptoms.

Adult↗