Minimal access general surgery: the dawn of a new era

Article Abstract:

One of the most exciting developments in surgical technique in recent memory has been interventional laparoscopy, a therapeutic surgical procedure performed without major incision. A laparoscope, an illuminated tube with an optical system, is inserted into the body cavity; this provides the surgeon a view of the surgical field. Instruments such as forceps, snares, and probes are inserted into the body cavity through other small incisions. The surgical manipulation is observed through the laparoscope. Widespread acceptance of laparoscopic cholecystectomy (removal of the gallbladder) has been achieved in less than 18 months. This procedure is performed through several small incisions made in the abdomen, in contrast with the traditional major subcostal (below the ribs) abdominal incision necessary for traditional cholecystectomy. Various instruments are inserted into the abdomen under video control that are used to manipulate and finally remove the gallbladder. The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) has been established to promote gastrointestinal (stomach and bowel) endoscopy. SAGES has published guidelines for clinical application of these procedures. The American College of Surgeons has stated that laparoscopic surgery should be performed only by surgeons who are eligible to undertake traditional open cholecystectomy and other biliary procedures. SAGES had provided postgraduate educational courses in interventional laparoscopy for surgeons. Although the incisions for these procedures may be small, the surgery and the potential for complications are major and require a skilled surgeon. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Innovations, Social policy, Endoscopic surgery, editorial, American College of Surgeons

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Results of laparoscopic cholecystectomy in a university hospital

Article Abstract:

Laparoscopic cholecystectomy is a minimally invasive procedure for removal of the gallbladder. It is carried out through several small abdominal incisions through which a laparoscope (an illuminated optical instrument) and surgical instruments are inserted. A video monitor displays images recorded by the laparoscope, while the surgeon manipulates and removes the gallbladder. This technique has become increasingly popular and in some hospitals, 80 to 90 percent of all cholecystectomies are performed by laparoscopic techniques. A report is presented of the first 100 laparoscopic cholecystectomies performed by a single surgeon at a university hospital. Chronic cholecystitis was the diagnosis of 92 of the 100 patients; other reasons for operation included acute cholecystitis (5), cholecystitis without gallstones (2) and gallstones without symptoms (1). Cholangiography (X-ray examination of the bile ducts) was performed on 88 patients; 3 patients were found to have stones in the common duct. Laparoscopic technique was abandoned in two patients who subsequently underwent open cholecystectomy. Complications of laparoscopic cholecystectomy included duct injury (1), bile leak (2), wound complication (4), and atelectasis (1). All except three patients left the hospital within 24 hours of surgery. Individual hospital fees averaged $828 less than the usual cost of standard open cholecystectomy. These results support the view that laparoscopic cholecystectomy is safe, cost effective and improves patient recovery time. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Complications and side effects, Surgery, Cholecystectomy, Gallbladder

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