A practical approach to laparoscopic cholecystectomy

Article Abstract:

Laparoscopic cholecystectomy is a new, minimally invasive method of removing the gallbladder. Strong commercial interests as well as technical advances have led to increased availability of the equipment needed to perform this surgery. This procedure is quickly becoming available to patients, despite the relative absence of clinical trials. Laparoscopic cholecystectomy utilizes the laparoscope, an instrument that allows for visualization of internal organs, and the procedure is performed through several small abdominal incisions. Under laparoscopic visualization, the gallbladder is manipulated and finally removed. A report is presented of a favorable experience with this procedure and its cost-effectiveness. There were 500 consecutive cholecystectomies, studied prospectively. The laparoscopic procedure was attempted in 96 percent of patients, and was accomplished in 95 percent of these attempts. There were no deaths or cases of bile duct injury. Only one patient required reoperation for any reason, and only two patients were suspected of having retained stone. A comparison was made between electrocautery and laser as the energy source for surgical dissection. Electrocautery use reduced operating time by 20 minutes and hospital charges to the patient by $546, compared with use of laser. Use of a reusable trocar (surgical instrument for removing fluid from body cavities) and selective use of cholangiography (X-ray examination of the bile ducts) also reduced costs without loss of benefit to the patient. Use of laser for this procedure appears to be unnecessary and expensive (initial cost to hospitals may be $120,000). It is concluded that laparoscopic cholecystectomy is a safe procedure. Its cost-effectiveness may be improved by utilizing electrocautery and a reusable trocar, as well as selective use of cholangiography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, Statistics, Biliary tract Radionuclide imaging

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Laser or electrocautery for laparoscopic cholecystectomy?

Article Abstract:

Laparoscopic cholecystectomy is a new, minimally-invasive method of removing the gallbladder. It is performed using several small abdominal incisions through which a laparoscope and trocars (sharply pointed instruments), fitted with surgical instruments, are inserted. Under laparoscopic visualization the gallbladder is manipulated and finally removed. There is considerable controversy over the best source of energy to achieve gallbladder dissection: electrocautery or laser. Both electrocautery (monopolar radio frequency electricity) and laser (collimated coherent light) produce the required tissue damage and incision by the generation of heat. The main differences between these two energy sources are the predictability of injury, selective absorption of free laser beam energy, the ability to coagulate (stop bleeding), and cost. Two small retrospective studies have been performed which compare laser with electrocautery. One study found that electrocautery was associated with faster dissection and easier bleeding control; and the laser technique extended the operation time by 20 minutes, and increased hospital charges $500. An early prospective trial shows a trend toward longer dissection using laser. However, lasers may be more precise. Advertising of laser-assisted laparoscopic cholecystectomy has received favorable response from the public; many believe it is the laser that makes the procedure possible. It is inappropriate to suggest that laser laparoscopic cholecystectomy is 'the standard of care' as has been advertised in many surgical publications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Equipment and supplies, Abdomen, Laparotomy, Laser coagulation, Laser photocoagulation, Electrosurgery

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Electrocautery is superior to laser for laparoscopic cholecystectomy

Article Abstract:

Cholecystectomy (removal of the gallbladder) can be performed with the use of a laparoscope, an instrument consisting of an illuminated tube that can be inserted through the abdominal wall to permit visualization of the internal organs. Patients who undergo this procedure usually return home the day after surgery and are able to resume nonmanual work within three to five days. Surgeons being trained to perform laparoscopic cholecystectomy are also instructed in the physics and application of laser energy, which is used to perform the dissection (cutting). The authors report on having performed 350 consecutive laparoscopic cholecystectomies without any patient deaths, need for reoperation, or ductal injury; of these procedures, the last 280 cases were performed without the use of laser equipment, but rather with electrocautery (use of a heated wire to cauterize, or destroy tissue). The surgeons found electrocautery to be superior to the laser technique. Laser equipment is expensive (costing around $120,00), whereas all operating rooms already have electrocautery units in place. It is recommended that laser units not be purchased solely in order to perform laparoscopic cholecystectomy; this large amount of money can be put to better use. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Innovations, editorial, Gallbladder

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