1
|
Wittmaack MCN, Conceição MEBAM, Vera MCM, Faccini RI, Sembenelli G, Montanhim GL, de Menezes MP, Rocha FDL, Aires LPN, Moraes PC. Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model. Acta Cir Bras 2023; 38:e383523. [PMID: 38055391 PMCID: PMC10691173 DOI: 10.1590/acb383523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/23/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. METHODS Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. RESULTS Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. CONCLUSIONS LC can be performed using different techniques, although the use of EBVS is highly recommended.
Collapse
Affiliation(s)
- Monica Carolina Nery Wittmaack
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | | | - María Camila Maldonado Vera
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Rachel Inamassu Faccini
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Guilherme Sembenelli
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Gabriel Luiz Montanhim
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Mareliza Possa de Menezes
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Fabiana Del Lama Rocha
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Luiz Paulo Nogueira Aires
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| | - Paola Castro Moraes
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – School of Agrarian Sciences and Veterinary – Department of Veterinary Surgery – Jaboticabal (São Paulo) – Brazil
| |
Collapse
|
2
|
Ortenzi M, Agresta F, Vettoretto N, Gerardi C, Allocati E, Botteri E, Montori G, Balla A, Arezzo A, Piatto G, Sartori A, Antoniou S, Podda M. Use of High Energy Devices (HEDs) versus electrocautery for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials. Surg Endosc 2023:10.1007/s00464-023-10060-7. [PMID: 37074420 DOI: 10.1007/s00464-023-10060-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION According to the literature, there is no clear definition of a High Energy Devices (HEDs), and their proper indications for use are also unclear. Nevertheless, the flourishing market of HEDs could make their choice in daily clinical practice arduous, possibly increasing the risk of improper use for a lack of specific training. At the same time, the diffusion of HEDs impacts the economic asset of the healthcare systems. This study aims to assess the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). MATERIALS AND METHODS On behalf of the Italian Society of Endoscopic Surgery and New Technologies, experts performed a systematic review and meta-analysis and synthesised the evidence assessing the efficacy and safety of HEDs compared to electrocautery devices while performing laparoscopic cholecystectomy (LC). Only randomised controlled trials (RCTs) and comparative observational studies were included. Outcomes were: operating time, bleeding, intra-operative and post-operative complications, length of hospital stay, costs, and exposition to surgical smoke. The review was registered on PROSPERO (CRD42021250447). RESULTS Twenty-six studies were included: 21 RCTs, one prospective parallel arm comparative non-RCT, and one retrospective cohort study, while three were prospective comparative studies. Most of the studies included laparoscopic cholecystectomy performed in an elective setting. All the studies but three analysed the outcomes deriving from the utilisation of US sources of energy compared to electrocautery. Operative time was significantly shorter in the HED group compared to the electrocautery group (15 studies, 1938 patients; SMD - 1.33; 95% CI - 1.89 to 0.78; I2 = 97%, Random-effect). No other statistically significant differences were found in the other examined variables. CONCLUSIONS HEDs seem to have a superiority over Electrocautery while performing LC in terms of operative time, while no difference was observed in terms of length of hospitalisation and blood loss. No concerns about safety were raised.
Collapse
Affiliation(s)
- Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
| | - Ferdinando Agresta
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Nereo Vettoretto
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Chiara Gerardi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eleonora Allocati
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Montichiari, Brescia, Italy
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Andrea Balla
- General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Giacomo Piatto
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Alberto Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy
| | - Stavros Antoniou
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| |
Collapse
|
3
|
Vettoretto N, Foglia E, Gerardi C, Lettieri E, Nocco U, Botteri E, Bracale U, Caracino V, Carrano FM, Cassinotti E, Giovenzana M, Giuliani B, Iossa A, Milone M, Montori G, Peltrini R, Piatto G, Podda M, Sartori A, Allocati E, Ferrario L, Asperti F, Songia L, Garattini S, Agresta F. High-energy devices in different surgical settings: lessons learnt from a full health technology assessment report developed by SICE (Società Italiana di Chirurgia Endoscopica). Surg Endosc 2023; 37:2548-2565. [PMID: 36333498 PMCID: PMC9638482 DOI: 10.1007/s00464-022-09734-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present paper aims at evaluating the potential benefits of high-energy devices (HEDs) in the Italian surgical practice, defining the comparative efficacy and safety profiles, as well as the potential economic and organizational advantages for hospitals and patients, with respect to standard monopolar or bipolar devices. METHODS A Health Technology Assessment was conducted in 2021 assuming the hospital perspective, comparing HEDs and standard monopolar/bipolar devices, within eleven surgical settings: appendectomy, hepatic resections, colorectal resections, cholecystectomy, splenectomy, hemorrhoidectomy, thyroidectomy, esophago-gastrectomy, breast surgery, adrenalectomy, and pancreatectomy. The nine EUnetHTA Core Model dimensions were deployed considering a multi-methods approach. Both qualitative and quantitative methods were used: (1) a systematic literature review for the definition of the comparative efficacy and safety data; (2) administration of qualitative questionnaires, completed by 23 healthcare professionals (according to 7-item Likert scale, ranging from - 3 to + 3); and (3) health-economics tools, useful for the economic evaluation of the clinical pathway and budget impact analysis, and for the definition of the organizational and accessibility advantages, in terms of time or procedures' savings. RESULTS The literature declared a decrease in operating time and length of stay in using HEDs in most surgical settings. While HEDs would lead to a marginal investment for the conduction of 178,619 surgeries on annual basis, their routinely implementation would generate significant organizational savings. A decrease equal to - 5.25/-9.02% of operating room time and to - 5.03/-30.73% of length of stay emerged. An advantage in accessibility to surgery could be hypothesized in a 9% of increase, due to the gaining in operatory slots. Professionals' perceptions crystallized and confirmed literature evidence, declaring a better safety and effectiveness profile. An improvement in both patients and caregivers' quality-of-life emerged. CONCLUSIONS The results have demonstrated the strategic relevance related to HEDs introduction, their economic sustainability, and feasibility, as well as the potentialities in process improvement.
Collapse
Affiliation(s)
- Nereo Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy.
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Chiara Gerardi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Emanuele Lettieri
- Dipartimento di Ingegneria Gestionale, Politecnico di Milano, Milan, Italy
| | - Umberto Nocco
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
| | - Emanuele Botteri
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Chirurgia, V.le Ciotti 154, 25018, Montichiari, BS, Italy
| | - Umberto Bracale
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Valerio Caracino
- U.O.C. Chirurgia Generale e d'Urgenza, AUSL Pescara, Pescara, Italy
| | | | - Elisa Cassinotti
- Chirurgia Generale, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Giovenzana
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Beatrice Giuliani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome Sapienza Polo Pontino, Rome, Italy
| | - Marco Milone
- U.O.C. Chirurgia Generale, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
| | - Giulia Montori
- U.O.C. Chirurgia Generale, Ospedale di Vittorio Veneto, Treviso, Italy
| | - Roberto Peltrini
- U.O.C. Chirurgie Generale e Oncologica Mini Invasiva, A.O.U. Policlinico Federico II, Naples, Italy
| | - Giacomo Piatto
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Mauro Podda
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Cagliari, Cagliari, Italy
| | - Alberto Sartori
- UOC Chirurgia Generale e d'Urgenza, Ospedale di Montebelluna (TV), AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Federica Asperti
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Letizia Songia
- S.C. Ingegneria Clinica, ASST Grande Ospedale Metropolitano Niguarda and Associazione Italiana Ingegneri Clinici, Milan, Italy
- SC Ingengeria Clinica, ASST di Lecco, Lecco, Italy
| | - Silvio Garattini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | | |
Collapse
|
4
|
Garzali IU, Aburumman A, Alsardia Y, Alabdallat B, Wraikat S, Aloun A. Is fundus first laparoscopic cholecystectomy a better option than conventional laparoscopic cholecystectomy for difficult cholecystectomy? A systematic review and meta-analysis. Updates Surg 2022; 74:1797-1803. [PMID: 36207659 DOI: 10.1007/s13304-022-01403-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
The gallstone disease prevalence is up to 27% in the general adult population. Though most of the patients are asymptomatic, about 1-4% of these patients became symptomatic every year and will require treatment. Fundus first laparoscopic cholecystectomy (FFLC) was first reported by Cooperman in 1990 when he utilized the approach to safely perform LC for patients with acute cholecystitis and dense adhesion around the calot's triangle which precluded safe dissection. Some surgeons reported that the FFLC may be quicker than the traditional dissection starting at the Calot's triangle, although no randomized trial has been undertaken to confirm that. We aim to perform this systematic review and meta-analysis to compare outcome of fundal first laparoscopic cholecystectomy with conventional laparoscopic cholecystectomy. Three reviewers independently searched the Pubmed, medline, google schoolar, Cochrane library and Embase databases for prospective or retrospective articles comparing outcomes of fundus first LC and conventional LC. The search terms were "retrograde cholecystectomy", "antegrade cholecystectomy", "fundus first cholecystectomy", "fundus down cholecystectomy", and "dome down cholecystectomy". Studies were selected based on predetermined criteria and data were extracted from the study for meta-analysis. Twelve studies were included for meta-analysis. Our analysis revealed that FFLC is associated with less conversion to open surgery, less time of surgery, less risk of bile duct injuries and shorter duration of hospital stay compared conventional cholecystectomy in patients with difficult cholecystectomy. In conclusion, fundus first laparoscopic cholecystectomy is a safer alternative to conventional laparoscopic cholecystectomy in patients with difficult cholecystectomy.
Collapse
Affiliation(s)
| | | | | | | | | | - Ali Aloun
- King Hussein Medical Center, Amman, Jordan.
| |
Collapse
|
5
|
Fisher AT, Bessoff KE, Khan RI, Touponse GC, Yu MM, Patil AA, Choi J, Stave CD, Forrester JD. Evidence-based surgery for laparoscopic cholecystectomy. Surg Open Sci 2022; 10:116-134. [PMID: 36132940 PMCID: PMC9483801 DOI: 10.1016/j.sopen.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Laparoscopic 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. Methods We 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. Results Fifty-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. Conclusion Key operative steps of laparoscopic cholecystectomy should be informed by both compiled data and surgeon preference/patient considerations.
Collapse
|
6
|
Fundus first as the standard technique for laparoscopic cholecystectomy. Sci Rep 2019; 9:18736. [PMID: 31822771 PMCID: PMC6904718 DOI: 10.1038/s41598-019-55401-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/27/2019] [Indexed: 01/10/2023] Open
Abstract
In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.
Collapse
|
7
|
Jiang HP, Liu YD, Li YS, Shen ZL, Ye YJ. Ultrasonic versus electrosurgical device for laparoscopic cholecystectomy: A systematic review with meta-analysis and trial sequential analysis. Int J Surg 2017; 40:24-32. [PMID: 28219818 DOI: 10.1016/j.ijsu.2017.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/10/2017] [Accepted: 02/15/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Ultrasonic and electrosurgical energy dissectors are main dissecting devices widely used for the laparoscopic cholecystectomy. Trial sequential analyses can establish whether firm evidence favoring a specific device has been reached from accumulated literature. To explore this, we performed a meta-analysis and trial sequential analyses. METHODS PubMed, Embase, and the Cochrane Library were searched from inception to October 2016. The primary outcome was operative time. The secondary outcomes included adverse events during operation, postoperative complications, intra-abdominal collection, hospital stay, hospital costs, and sick leave or time to full recovery. Relative risks (RRs) were calculated for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Finally, we calculated numbers needed to treat to examine benefits of the ultrasonic device. RESULTS We identified 19 studies. Compared with the electrosurgical device, the ultrasonic device led to shorter operative time (MD, -14.86; 95% confidence interval (CI), -21.45 to -8.27; P < 0.00001), less blood loss (MD, -47.24; 95% CI, -79.57 to -14.90; P = 0.004), fewer gallbladder perforations (RR, 0.45; 95% CI, 0.35 to 0.57; P < 0.00001), shorter hospital stay (MD, -0.37; 95% CI, -0.61 to -0.14; P = 0.002), and fewer abdominal pains (MD, -0.95; 95% CI, -1.40 to -0.50; P < 0.0001). The trial sequential analysis demonstrated that the cumulative z-curve crossed the trial sequential monitoring and reached the required information size of the operative time. The numbers needed to treat to avoid one gallbladder perforation and postoperative nausea, respectively, were 7 and 15. CONCLUSIONS Compared with the electrosurgery device, the ultrasonic device could be superior with more clinical effectiveness. The trial sequential analysis demonstrated that further studies about the operative time were not needed.
Collapse
Affiliation(s)
- Hong-Peng Jiang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China
| | - Ya-Dong Liu
- Department of Urinary Surgery, The First Clinical Hospital, Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yan-Sen Li
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China
| | - Zhan-Long Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China.
| | - Ying-Jiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, People's Republic of China.
| |
Collapse
|
8
|
Otsuka S, Kaneoka Y, Maeda A, Takayama Y, Fukami Y, Onoe S. Ultrasonic energy device versus monopolar energy device in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Updates Surg 2016; 69:55-60. [DOI: 10.1007/s13304-016-0412-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/09/2016] [Indexed: 11/28/2022]
|
9
|
Aspinen S, Harju J, Kinnunen M, Juvonen P, Kokki H, Eskelinen M. A randomized multicenter study of minilaparotomy cholecystectomy versus laparoscopic cholecystectomy with ultrasonic dissection in both groups. Scand J Gastroenterol 2016; 51:354-9. [PMID: 26414236 DOI: 10.3109/00365521.2015.1091496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Ultrasonic dissection (UsD) has been used in laparoscopic cholecystectomy (LC), though it is not the golden standard technique. Applying UsD to cholecystectomy by minilaparotomy (MC) is less common and there are no prospective randomized trials comparing these two techniques. Therefore, we conducted the present study to investigate the use of the UsD in the MC versus the LC procedure. MATERIAL AND METHODS Initially 104 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 53) or LC (n = 51) groups, both groups using UsD, over a period of 2 years (2013-2015). The study groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. RESULTS The demographic variables and the surgical data were similar in the study groups. Similar low postoperative pain scores were reported in the two study groups during the first four hours after surgery. The incidence of nausea/vomiting was similar between the two study groups, 47% in the MC group versus 42% in the LC group. However, the patients in the MC group were treated more frequently with antiemetics, the incidence being 39% in the MC group versus 21% in the LC group (p = 0.02). The pain at rest at 24h after the surgery was similar in the two study groups, but the LC patients reported less pain at the normal activity, the mean of numerical rating scale (NRS) of 0-10 score being 3.9 in the MC group versus 2.9 in the LC group (p = 0.05), and the pain at the quick movement/coughing, the mean NRS being 4.9 in the MC group versus 3.2 in the LC group (p = 0.005). The length of sick leave was 17.4 days in the MC group and 14.4 days in the LC group (p = 0.05). CONCLUSION Our results suggest that both MC and LC are feasible and safe options for mini-invasive cholecystectomy. A new finding with clinical relevance in the present work is a relatively similar short-term outcome in the MC and LC although the LC patients reported significantly lower pain score 24 hours postoperatively and a shorter convalescence.
Collapse
Affiliation(s)
- Samuli Aspinen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Jukka Harju
- b Department of Surgery , Helsinki University Central Hospital , Helsinki , Finland
| | - Mari Kinnunen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Petri Juvonen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Hannu Kokki
- c Department of Anaesthesia and Operative Services , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| | - Matti Eskelinen
- a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland
| |
Collapse
|
10
|
Ramos AC, Ramos MG, Galvão-Neto MDP, Marins J, Bastos ELDS, Zundel N. Total clipless cholecystectomy by means of harmonic sealing. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:53-6. [PMID: 25861071 PMCID: PMC4739249 DOI: 10.1590/s0102-67202015000100014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/06/2015] [Indexed: 12/12/2022]
Abstract
Background In traditional laparoscopic cholecistectomy, the cystic duct and artery are
commonly closed by metallic clips just before their division. Although the
placement of these clips for occluding cystic artery and duct can be considered
safe, biliary leaks and bleeding may occur especially by its dislodgement. Aim To report a prospective case-series in total clipless cholecystectomy by means of
harmonic shears for closure and division of the artery and cystic duct as well
removal of the gallbladder from the liver. Methods Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy
where the sealing and division of cystic artery and duct was carried out only by
harmonic shears. The intact extracted gallbladder was submitted to a reverse
pressure test for assessment of the technique safety by means of CO2
insuflation. Results The most common indication for surgery was gallstones. The mean operative time was
26 min and all gallbladders were dissected intact from the liver bed. There was no
mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The
reverse pressure test showed that all specimens support at least 36-mmHg of
pressure without leaking. Conclusions The harmonic shears is effective and safe in laparoscopic cholecystectomy as a
sole instrument for sealing and division of the artery and cystic duct. The main
advantages could be related to the safety and decreased operative time.
Collapse
|
11
|
Sran H, Sebastian J, Hossain MA. Electrosurgical devices: are we closer to finding the ideal appliance? A critical review of current evidence for the use of electrosurgical devices in general surgery. Expert Rev Med Devices 2016; 13:203-15. [DOI: 10.1586/17434440.2016.1134312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
12
|
Lee JH, Han G, Kim YJ, Jung MS, Choi D. A Technique for Simultaneous Cholecystectomy During Bariatric Surgery. JSLS 2015; 19:JSLS.2015.00072. [PMID: 26648677 PMCID: PMC4653580 DOI: 10.4293/jsls.2015.00072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: Cholecystectomy performed during bariatric surgery is technically demanding. Herein is described a technique we term the Glissonian approach along with an evaluation of its effectiveness and safety. Methods: From April 1, 2009, through February 28, 2014, laparoscopic cholecystectomy was performed during laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in 38 patients with proven cholecystopathy on diagnostic imaging. Perioperative outcomes were compared between the patients operated on with the Glissonian approach and those who underwent conventional laparoscopic cholecystectomy. Results: The Glissonian approach was adopted in 13 patients—11 during LRYGB and 2 during LSG—and the conventional operation was performed on 16 patients during LRYGB and 9 during LSG. Mean body mass indexes were 40.1 kg/m2 in the Glissonian-approach group and 37.6 kg/m2 in the conventional group. Laparoscopic cholecystectomy by the Glissonian approach saved a mean operative time of 7 minutes compared with the operative time of the conventional operation. No surgical complications related to cholecystectomy were noted in either group. Conclusion: This simple technique can be performed safely in morbidly obese patients, with low resultant morbidity and acceptable operation times.
Collapse
Affiliation(s)
- Ju-Hee Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Guru Han
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yong Jin Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min-Sung Jung
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Dongho Choi
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study. Surg Endosc 2015; 30:3867-72. [DOI: 10.1007/s00464-015-4691-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
|
14
|
Sun ZC, Xu WG, Xiao XM, Yu WH, Xu DM, Xu HM, Gao HL, Wang RX. Ultrasonic dissection versus conventional electrocautery during gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials. Eur J Surg Oncol 2015; 41:527-33. [PMID: 25690648 DOI: 10.1016/j.ejso.2015.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/23/2014] [Accepted: 01/19/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Use of ultrasonic surgical instrument is gaining popularity for dissection and coagulation in open surgery. However, there is still no consensus on the efficacy and safety of its use compared with conventional surgical technique in open gastrectomy for gastric cancer. The aim of this meta-analysis was to evaluate the role and surgical outcomes of ultrasonic dissection (UD) compared with conventional electrocautery (EC). METHODS A systematic literature search was performed to identify all studies comparing UD and EC in gastric cancer surgery. Intraoperative and postoperative outcomes were compared using weighted mean differences (WMDs) and odds ratios (ORs). RESULTS Five studies were included in this meta-analysis, comprising 489 patients. Meta-analysis results showed that compared with EC, UD was associated with significantly shorter operation time (P = 0.03), less intraoperative blood loss (P = 0.002), lower morbidity (P = 0.02), and reduced postoperative hospital stay (P = 0.03). However, there was no significant difference between the two surgical techniques with regards to postoperative abdominal drainage (P = 0.17), and total cost in hospital (P = 0.59). CONCLUSIONS Compared to EC, the use of UD during open gastrectomy can provide several improved outcomes for operation time, intraoperative blood loss, overall morbidity, and postoperative hospital stay. It appears that UD can be used instead of conventional EC in open gastric cancer surgery, although more larger trials with long follow-up should be performed.
Collapse
Affiliation(s)
- Z C Sun
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong, China
| | - W G Xu
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong, China
| | - X M Xiao
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong, China.
| | - W H Yu
- Epidemiology and Statistics Teaching and Research Section, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - D M Xu
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong, China
| | - H M Xu
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong, China
| | - H L Gao
- Department of General Surgery, Weifang People's Hospital, Weifang 261041, Shandong, China
| | - R X Wang
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| |
Collapse
|
15
|
Harju J, Juvonen P, Kokki H, Remes V, Scheinin T, Eskelinen M. Minilaparotomy cholecystectomy with ultrasonic dissection versus conventional laparoscopic cholecystectomy: a randomized multicenter study. Scand J Gastroenterol 2013; 48:1317-23. [PMID: 23971855 DOI: 10.3109/00365521.2013.822545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Cholecystectomy by minilaparotomy (MC) or by laparoscopy (LC) has been shown to have equal results of both early and late recovery. Although, the ultrasonic dissection (UsD) technique has seen used in LC, the technique is rarely used in MC. MATERIAL AND METHODS Initially, 88 patients with uncomplicated symptomatic gallstones were randomized into MC with UsD (n = 44) or conventional LC (n = 44) over a 2-year period (2010-2012). The two groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score. Results. Both groups were similar in terms of the operative time and the time in the operation theatre, the success of day-surgery and satisfaction with the procedure. The MC group had significantly less postoperative pain than the LC group, p = 0.002, and the MC group used less analgesics doses during the first 24 h: 2.8 (1.2) doses vs. 3.8 (1.4) doses, p = 0.003. The convalescence needed was 3 days shorter in the MC group, 7 (3) days, than that in the LC-group, 10 (8) days, p = 0.024. In the MC group 4 patients and in the LC group 11 (p = 0.046) required more than 14 days of sick leave. In the MC group there was one and in the LC group two conversions to open surgery. CONCLUSION The patients in the MC group had less early postoperative pain and had a shorter convalescence than the patients in the LC group.
Collapse
Affiliation(s)
- Jukka Harju
- Department of Surgery, Helsinki University Central Hospital , Helsinki , Finland
| | | | | | | | | | | |
Collapse
|
16
|
Tempé F, Jänes A, Cengiz Y. Cost analysis comparing ultrasonic fundus-first and conventional laparoscopic cholecystectomy using electrocautery. Surg Endosc 2013; 27:2856-9. [DOI: 10.1007/s00464-013-2841-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/21/2013] [Indexed: 10/26/2022]
|
17
|
Hartwig W, Gluth A, Büchler MW. [Minimally invasive surgical therapy of acute cholecystitis]. Chirurg 2013; 84:191-6. [PMID: 23435484 DOI: 10.1007/s00104-012-2357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Acute cholecystitis is the most common complication of cholecystolithiasis. It develops in about 10 % of symptomatic patients and gangrenous cholecystitis, gallbladder perforation, gallbladder empyema, or abscesses are typical complications. Cholecystectomy is the most relevant therapy to achieve pain reduction, to prevent the progression of inflammation or local complications and to minimize the risk of recurrence. Surgical therapy can be supported by medical and interventional treatment modalities depending on the severity of the disease. The present review summarizes the surgical aspects in acute cholecystitis with a focus on laparoscopic cholecystectomy which is the gold standard of therapy.
Collapse
Affiliation(s)
- W Hartwig
- Klinik für Allgemein-Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Deutschland.
| | | | | |
Collapse
|
18
|
Mahabaleshwar V, Kaman L, Iqbal J, Singh R. Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial. Can J Surg 2012; 55:307-11. [PMID: 22854110 DOI: 10.1503/cjs.000411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Ultrasonic dissection has been suggested as an alternative to monopolar electrocautery in laparoscopic cholecystectomy because it generates less tissue damage and may have a lower incidence of gallbladder perforation. We compared the 2 methods to determine the incidence of gallbladder perforation and its intraoperative consequences. METHODS We conducted a prospective randomized controlled trial between July 2008 and December 2009 involving adult patients with symptomatic gall stone disease who were eligible for laparoscopic cholecystectomy. Patients were randomly assigned before administration of anesthesia to electrocautery or ultrasonic dissection. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stones spillage, lens cleaning, duration of surgery and estimation of risk of gallbladder in the presence of complicating factors. RESULTS We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, previous abdominal surgeries, preoperative ultrasonography findings and intraoperative complications. The overall incidence of gallbladder perforation was 28.3% (40.0% in the electrocautery v. 16.7% in the ultrasonic dissection group, p = 0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in ultrasonic group (p = 0.045). Lens cleaning time (p = 0.015) and duration of surgery (p = 0.001) were longer in the electrocautery than the ultrasonic dissection group. There was no statistical difference in stone spillage between the groups (p = 0.62). CONCLUSION Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.
Collapse
Affiliation(s)
- Varun Mahabaleshwar
- The Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | |
Collapse
|
19
|
Xiong J, Altaf K, Huang W, Javed MA, Mukherjee R, Mai G, Hu W, Sutton R, Liu X. A meta-analysis of randomized clinical trials that compared ultrasonic energy and monopolar electrosurgical energy in laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2012; 22:768-77. [PMID: 22967036 DOI: 10.1089/lap.2012.0157] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Currently, monopolar electrical energy is still widely used as the main source of energy for laparoscopic cholecystectomy (LC). However, some studies have suggested that the use of ultrasonic energy is more advantageous. This meta-analysis pooled the currently published randomized controlled trials comparing the safety and efficacy of ultrasonic energy and monopolar electrical energy in LC. MATERIALS AND METHODS MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials for relevant articles published between January 1985 to February 2012 by using the search terms "laparoscopic cholecystectomy," "electrocoagulation," "electrosurgery," "ultrasonics," "ultrasonic therapy," and "dissection." Intraoperative and postoperative measures and complications were evaluated. RESULTS Eight high-quality randomized controlled trials with 1056 patients were included. Differences in mean operation time, mean blood loss, mean hospital stay, gallbladder perforation, and postoperative abdominal pain score at 24 hours were statistically significant between the two groups, in favor of the use of ultrasonic energy. However, there were no differences in operation conversion, bile leakage, intra-abdominal collections, and postoperative nausea at 24 hours. CONCLUSIONS Ultrasonic energy is as safe and effective as electrosurgical energy and potentially might be safer in LC. However, the financial implications of this technical modality need to be established in cost-effectiveness analysis.
Collapse
Affiliation(s)
- Junjie Xiong
- Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
Collapse
Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Day case laparoscopic cholecystectomy carried out using the harmonic scalpel: analysis of a standard procedure. Surg Laparosc Endosc Percutan Tech 2011; 20:20-3. [PMID: 20173615 DOI: 10.1097/sle.0b013e3181cd45f2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Our aim was to determine the efficiency and safety of laparoscopic cholecystectomy carried out using the harmonic scalpel as a day case procedure. METHODS A prospective study was done on patients presenting for Laparoscopic cholecystectomy. The harmonic scalpel was used with retrograde dissection. All patients were considered for discharge the same day unless considered medically unfit. RESULTS Laparoscopic cholecystectomy using the harmonic scalpel was carried out on 100 patients. Major complications were as follows: conversion to open procedure -1%, common bile duct injury -1%, and bile leak from the cystic duct stump -1%. Our same day discharge rate was 65%, and age more than 65 was the only independent predictor of overnight admission (P=0.009). CONCLUSIONS Laparoscopic cholecystectomy using the harmonic scalpel is associated with a low complication rate and a high-same-day discharge rate when carried out as a day case procedure.
Collapse
|
22
|
ten Broek RPG, Wilbers J, van Goor H. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection. Surg Endosc 2010; 25:1827-34. [PMID: 21140171 PMCID: PMC3109994 DOI: 10.1007/s00464-010-1474-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/11/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimizing peritoneal tissue injury during abdominal surgery has the benefit of reducing postoperative inflammatory response, pain, and adhesion formation. Ultrasonic dissection seems to reduce tissue damage. This study aimed to compare electrocautery and ultrasonic dissection in terms of peritoneal tissue ischemia measured by microdialysis. METHODS In this study, 18 Wistar rats underwent a median laparotomy and had a peritoneal microdialysis catheter implanted in the left lateral sidewall. The animals were randomly assigned to receive two standard peritoneal incisions parallel to the catheter by either ultrasonic dissection or electrocautery. After the operation, samples of microdialysis dialysate were taken every 2 h until 72 h postoperatively for measurements of pyruvate, lactate, glucose, and glycerol, and ratios were calculated. RESULTS The mean lactate-pyruvate ratio (LPR), lactate-glucose ratio (LGR), and glycerol concentration were significantly higher in the electrocautery group than in the ultrasonic dissection group until respectively 34, 48, and 48 h after surgery. The mean areas under the curve (AUC) of LPR, LGR, and glycerol concentration also were higher in the electrocautery group than in the ultrasonic dissection group (4,387 vs. 1,639, P=0.011; 59 vs. 21, P=0.008; 7,438 vs. 4,169, P=0.008, respectively). CONCLUSION Electrosurgery causes more ischemic peritoneal tissue damage than ultrasonic dissection.
Collapse
Affiliation(s)
- Richard P. G. ten Broek
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joyce Wilbers
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
23
|
Patel AG, Murgatroyd B, Carswell K, Belgaumkar A. Fundus-first transumbilical single-incision laparoscopic cholecystectomy with a cholangiogram: a feasibility study. Surg Endosc 2010; 25:954-7. [DOI: 10.1007/s00464-010-1240-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 07/01/2010] [Indexed: 01/02/2023]
|
24
|
Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010; 24:2368-86. [PMID: 20706739 DOI: 10.1007/s00464-010-1268-7] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/27/2010] [Indexed: 12/13/2022]
Affiliation(s)
- D Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
| | | | | | | |
Collapse
|
25
|
Lirici MM, Califano A. Management of complicated gallstones: Results of an alternative approach to difficult cholecystectomies. MINIM INVASIV THER 2010; 19:304-15. [DOI: 10.3109/13645706.2010.507339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
26
|
Abstract
INTRODUCTION Laparoscopic cholecystectomy is the gold standard for management of symptomatic gallstones. Electrocautery remains the main energy form used during laparoscopic dissection. However, due to its risks, search is continuous for safer and more efficient forms of energy. This review assesses the effects of dissection using ultrasonic energy compared with monopolar electrocautery during laparoscopic cholecystectomy. METHODS A literature search of the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, and EMBASE was performed. Studies included were trials that prospectively randomized adult patients with symptomatic gallstone disease to either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Data were collected regarding the characteristics and methodological quality of each trial. Outcome measures included operating time, gallbladder perforation rate, bleeding, bile leak, conversion rate, length of hospital stay and sick leave, postoperative pain and nausea scores, and influence on systemic immune and inflammatory responses. For metaanalysis, the statistical package RevMan version 4.2 was used. For continuous data, Weighted Mean Difference (WMD) was calculated with 95% confidence interval (CI) using the fixed effects model. For Categorical data, the Odds Ratio (OR) was calculated with 95% confidence interval using fixed effects model. RESULTS Seven trials were included in this review, with a total number of 695 patients randomized to 2 dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. No mortality was recorded in any of the trials. With ultrasonic dissection, operating time is significantly shorter in elective surgery (WMD -8.19, 95% CI -10.36 to -6.02, P<0.0001), acute cholecystitis (WMD -17, 95% CI -28.68 to -5.32, P=0.004), complicated cases (WMD -15, 95% CI -28.15 to -1.85, P=0.03), or if surgery was performed by trainee surgeons who had performed <10 procedures (P=0.043). Gallbladder perforation risk with bile leak or stone loss is lower (OR 0.27, 95% CI 0.17 to 0.42, P<0.0001 and OR 0.13, 95% CI 0.04 to 0.47, P=0.002 respectively), particularly in the subgroup of complicated cases (OR 0.24 95% CI 0.09 to 0.61, P=0.003). Mean durations of hospital stay and sick leave were shorter with ultrasonic dissection (WMD -0.3, 95% CI -0.51 to -0.09, P=0.005 and WMD -3.8, 95% CI -6.21 to -1.39, P=0.002 respectively), with a smaller mean number of patients who stayed overnight in the hospital (OR 0.18, 95% CI 0.03 to 0.89, P=0.04). Postoperative abdominal pain scores at 1, 4, and 24 hours were significantly lower with ultrasonic dissection as were postoperative nausea scores at 2, 4, and 24 hours. CONCLUSION Based on a few trials with relatively small patient samples, this review does not attempt to advocate the use of a single-dissection technology but rather to elucidate results that could be used in future trials and analyses. It demonstrates, with statistical significance, a shorter operating time, hospital stay and sick leave, lower gallbladder perforation risk especially in complicated cases, and lower pain and nausea scores at different postoperative time points. However, many of these potential benefits are subjective, and prone to selection, and expectation bias because most included trials are unblinded. Also the clinical significance of these statistical results has yet to be proved. The main disadvantages are the difficulty in Harmonic scalpel handling, and cost. Appropriate training programs may be implemented to overcome the first disadvantage. Cost remains the main universal issue with current ultrasonic devices, which outweighs the potential clinical benefits (if any), indicating the need for further cost-benefit analysis.
Collapse
Affiliation(s)
- Walid Sasi
- Department of General Surgery, St George's Hospital and Medical School, University of London, UK.
| |
Collapse
|
27
|
Kelly MD. Laparoscopic retrograde (fundus first) cholecystectomy. BMC Surg 2009; 9:19. [PMID: 20003333 PMCID: PMC2801662 DOI: 10.1186/1471-2482-9-19] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Accepted: 12/11/2009] [Indexed: 01/06/2023] Open
Abstract
Background Retrograde ("fundus first") dissection is frequently used in open cholecystectomy and although feasible in laparoscopic cholecystectomy (LC) it has not been widely practiced. LC is most simply carried out using antegrade dissection with a grasper to provide cephalad fundic traction. A series is presented to investigate the place of retrograde dissection in the hands of an experienced laparoscopic surgeon using modern instrumentation. Methods A prospective record of all LCs carried out by an experienced laparoscopic surgeon following his appointment in Bristol in 2004 was examined. Retrograde dissection was resorted to when difficulties were encountered with exposure and/or dissection of Calot's triangle. Results 1041 LCs were carried out including 148 (14%) emergency operations and 131 (13%) associated bile duct explorations. There were no bile duct injuries although conversion to open operation was required in six patients (0.6%). Retrograde LC was attempted successfully in 11 patients (1.1%). The age ranged from 28 to 80 years (mean 61) and there were 7 males. Indications were; fibrous, contracted gallbladder 7, Mirizzi syndrome 2 and severe kyphosis 2. Operative photographs are included to show the type of case where it was needed and the technique used. Postoperative stay was 1/2 to 5 days (mean 2.2) with no delayed sequelae on followup. Histopathology showed; chronic cholecystitis 7, xanthogranulomatous cholecystitis 3 and acute necrotising cholecystitis 1. Conclusions In this series, retrograde laparoscopic dissection was necessary in 1.1% of LCs and a liver retractor was needed in 9 of the 11 cases. This technique does have a place and should be in the armamentarium of the laparoscopic surgeon.
Collapse
Affiliation(s)
- Michael D Kelly
- Department of Upper GI Surgery, Frenchay Hospital, Bristol, UK.
| |
Collapse
|
28
|
Cengiz Y, Dalenbäck J, Edlund G, Israelsson LA, Jänes A, Möller M, Thorell A. Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial. Surg Endosc 2009; 24:624-30. [DOI: 10.1007/s00464-009-0649-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 06/19/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
|
29
|
Randomized clinical trial of torsional versus linear mode ultrasonically activated devices for laparoscopic cholecystectomy. Surg Endosc 2009; 23:1506-11. [DOI: 10.1007/s00464-009-0391-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 01/24/2009] [Indexed: 11/26/2022]
|
30
|
Vu T, Aguilo R, Marshall NC. Clipless technique of laparoscopic cholecystectomy using the harmonic scalpel. Ann R Coll Surg Engl 2009. [PMID: 18831871 DOI: 10.1308/003588408x321558a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- T Vu
- Department of Surgery, Newham University Hospital, London, UK
| | | | | |
Collapse
|
31
|
Vu T, Aguilo R, Marshall NC. Clipless Technique of Laparoscopic Cholecystectomy Using the Harmonic Scalpel. Ann R Coll Surg Engl 2008; 90:612. [DOI: 10.1308/rcsann.2008.90.7.612a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- T Vu
- Department of Surgery, Newham University Hospital London, UK
| | - R Aguilo
- Department of Surgery, Newham University Hospital London, UK
| | - NC Marshall
- Department of Surgery, Newham University Hospital London, UK
| |
Collapse
|
32
|
Tuveri M, Calò PG, Medas F, Tuveri A, Nicolosi A. Limits and advantages of fundus-first laparoscopic cholecystectomy: lessons learned. J Laparoendosc Adv Surg Tech A 2008; 18:69-75. [PMID: 18266578 DOI: 10.1089/lap.2006.0194] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fundus-first cholecystectomy is well recognized as a safe technique during open cholecystectomy (OC) because it minimizes the risk of injuries to the biliary structures at the Calot's triangle. Fundus-first laparoscopic cholecystectomy (FFLC), like the OC, has been proposed as a safe method to approach the cystic duct in cases of difficult anatomy in order to limit biliary injuries and to reduce the conversion rate. The aim of our study was to highlight the limits and advantages of the FFLC, in order to evaluate whether the potential complications are counterbalanced by the expected reduction of the conversion rate. METHODS We retrospectively analyzed 1965 consecutive cases of laparoscopic cholecystectomies performed for gallbladder disease from 1994 to 2005. Reasons for adoption of the FFLC, conversion to OC, and complications were compiled. RESULTS The FLC was performed in 29 cases (1.5%) and was successful in 23 patients (80%). The median operating time for the FFLC was 65 minutes (range, 40-170). In 6 patients (20%), FFLC was eventually converted to open operation. Intraoperative cholangiography (IOC) was performed successfully in 17 cases (74%). Common bile duct (CBD) stones were found in 6 cases (20%). Minor complications occurred in 6 patients (20%). No CBD injuries occurred. Two cases of residual CBD stones were treated postoperatively. Mortality rate was nil. CONCLUSIONS The FLC remains a safe option when dealing with patients with difficult anatomy at the Calot's triangle, but its adoption needs a good surgical judgment. Considering the high incidence of CBD stones in this series, the high failure rates in performing an IOC represent the most important limiting factor.
Collapse
Affiliation(s)
- Massimiliano Tuveri
- Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari, Italy.
| | | | | | | | | |
Collapse
|
33
|
Gurusamy KS, Tapuria N, Davidson BR. Methods of gallbladder dissection for laparoscopic cholecystectomy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Hospital and University College School of Medicine; University Department of Surgery; 9th Floor, Royal Free Hospital Pond Street London UK NW3 2QG
| | | | - Brian R Davidson
- Royal Free Hospital and University College School of Medicine; University Department of Surgery; 9th Floor, Royal Free Hospital Pond Street London UK NW3 2QG
| |
Collapse
|
34
|
Walldén J, Thörn SE, Lövqvist A, Wattwil L, Wattwil M. The effect of anesthetic technique on early postoperative gastric emptying: comparison of propofol-remifentanil and opioid-free sevoflurane anesthesia. J Anesth 2006; 20:261-7. [PMID: 17072689 DOI: 10.1007/s00540-006-0436-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 07/28/2006] [Indexed: 01/15/2023]
Abstract
PURPOSE A postoperative decrease in the gastric emptying (GE) rate may delay the early start of oral feeding and alter the bioavailability of orally administered drugs. The aim of this study was to compare the effect on early gastric emptying between two anesthetic techniques. METHODS Fifty patients (age, 19-69 years) undergoing day-case laparoscopic cholecystectomy were randomly assigned to received either total intravenous anesthesia with propofol/remifentanil/rocuronium (TIVA; n = 25) or inhalational opioid-free anesthesia with sevoflurane/rocuronium (mask induction; GAS; n = 25). Postoperative gastric emptying was evaluated by the acetaminophen method. After arrival in the recovery unit, acetaminophen (paracetamol) 1.5 g was given through a nasogastric tube, and blood samples were drawn during a 2-h period. The area under the serum-acetaminophen concentration curve from 0-60 min (AUC60), the maximal concentration (Cmax), and the time to reach C-max (Tmax) were calculated. RESULTS Twelve patients were excluded due to surgical complications (e.g., conversion to open surgery) and difficulty in drawing blood samples (TIVA, n = 7; GAS, n = 5). Gastric emptying parameters were (mean +/- SD): TIVA, AUC60, 2458 +/- 2775 min.micromol.l(-1); Cmax, 71 +/- 61 micromol.l(-1); and Tmax, 81 +/- 37 min; and GAS, AUC60, 2059 +/- 2633 min.micromol.l(-1); Cmax, 53 +/- 53 micromol.l(-1); and Tmax, 83 +/- 41 min. There were no significant differences between groups. CONCLUSION There was no major difference in early postoperative gastric emptying between inhalation anesthesia with sevoflurane versus total intravenous anesthesia with propofol-remifentanil. Both groups showed a pattern of delayed gastric emptying, and the variability in gastric emptying was high. Perioperative factors other than anesthetic technique may have more influence on gastric emptying.
Collapse
Affiliation(s)
- Jakob Walldén
- Department of Anesthesia, Sundsvall Hospital, 851 86, Sundsvall, Sweden
| | | | | | | | | |
Collapse
|
35
|
Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc 2006; 64:428-34. [PMID: 16923495 DOI: 10.1016/j.gie.2006.06.079] [Citation(s) in RCA: 230] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 06/20/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transgastric cholecystectomy is a natural orifice transluminal endoscopic surgery (NOTES) procedure that has been reported in 2 nonsurvival studies. Both studies detail substantial technical limitations, with only a 33% success rate when limited to 1 gastric incision site, despite the use of a multichannel locking endoscope. OBJECTIVE The aim of this study was to evaluate the feasibility and technical limitations of transcolonic cholecystectomy in a survival model. DESIGN Animal feasibility study. INTERVENTIONS Five pigs, under general anesthesia, were prepared with tap-water enemas, a peranal antibiotic lavage, and a Betadine rinse. A dual-channel endoscope was advanced into the peritoneum through an anterior, transcolonic incision 15 to 20 cm from the anus. After cystic duct and artery ligation, dissection of the gallbladder was achieved by using grasping and cutting instruments. After removing the gallbladder, the colonic incision was closed by using Endoloops and/or endoclips. The animals lived for 2 weeks after the procedure, then they were euthanized, and a necropsy was performed. RESULTS All 5 gallbladders were successfully resected. Four of the 5 animals flourished in the postoperative period, with appropriate weight gain. In 1 animal, complete closure of the colonic incision was not possible, and it was euthanized at 48 hours for suspected peritonitis. CONCLUSIONS This study reports the first transcolonic organ resection and demonstrates the first successful NOTES cholecystectomy in a survival model. The transcolonic approach provided improved endoscope stability and biliary exposure compared with the transgastric route, and complete incision closure appeared critical for procedural success.
Collapse
Affiliation(s)
- Reina D Pai
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | | | | | | | | | | |
Collapse
|