The Los Angeles experience with laparoscopic cholecystectomy

Article Abstract:

One of the most intriguing and exciting topics in general surgery today is laparoscopic cholecystectomy. Cholecystectomy, or removal of the gallbladder, has traditionally been performed through an upper abdominal incision. Laparoscopic cholecystectomy is carried out through several small incisions in the abdomen. Through these incisions, a laparoscope (instrument used for visualizing internal organs) and several trocars (sharply pointed instruments) are inserted. Under laparoscopic visualization, the gallbladder is removed. Surgeons who perform this procedure should first be competent in performing diagnostic laparoscopic procedures. Training should include hands-on experience and one-to-one contact with the tutor. Since the introduction of laparoscopic cholecystectomy, open cholecystectomies (the traditional approach) have accounted for only one-third of all cholecystectomies performed at one hospital in Los Angeles, California. Within a one-year period, 418 laparoscopic cholecystectomies were performed at this hospital. Twenty-two patients (5 percent) required progression of the laparoscopic procedure to open cholecystectomy. Cholangiography (X-ray examination of the bile ducts) was attempted routinely, and was successful in 90 percent of the attempts. The average hospital stay was one day. There is no clear-cut answer to the best treatment for patients with slightly elevated liver function tests but no jaundice, or for patients whose cholangiograms show unsuspected stones. It is recommended that in order to keep morbidity and mortality low, surgeons performing this procedure should be well trained. Training in this procedure should be included in the curriculum for surgical residents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Training, Los Angeles, California, Surgical technology

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Laparoscopic cholecystectomy

Article Abstract:

Laparoscopic cholecystectomy, or removal of the gallbladder using a laparoscope, has been performed successfully. A laparoscope is a narrow tube with an optical system. When it is inserted through a small abdominal incision, a laparoscope provides visualization inside the abdominal cavity. Surgical instruments can be fitted to the laparoscope to carry out various surgical procedures. Laparoscopic cholecystectomy has several advantages over traditional cholecystectomy which is performed through a much larger incision in the abdominal wall. Because there is no major incision or opening of the abdomen in the new procedure, there is virtually no postoperative pain. The patient can usually leave the hospital in one to two days, and return to full activity within one week. This technique has obvious benefits for patients and is considerably less costly. Future research should examine related issues, such as using procedures to crush gall stones prior to laparoscopy, and laser or electrosurgery to dissect the gallbladder from the liver bed. The use of laparoscopic cholecystectomy will increase dramatically, and there are serious needs to adequately train surgeons and confine this surgical technique to certain centers. These centers should be responsible for conducting research studies and training programs. Since laparoscopic cholecystectomy may progress to open surgery in some cases, the surgeon performing the procedure should also be credentialed in general biliary (gall bladder) surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, editorial, Gallbladder

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Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy?

Article Abstract:

During traditional cholecystectomy (gallbladder removal performed through a large upper abdominal incision) some surgeons use cholangiography (radiographic examination of the bile ducts) routinely, other surgeons use this technique only selectively. There are several technical problems involved in performing intraoperative cholangiograms, but they can be helpful in providing a 'road map' in difficult cases where the anatomy is obscured or congenitally abnormal, or when unsuspected stones are found. During laparoscopic cholecystectomy, a minimally-invasive procedure performed through several small abdominal incisions using laparoscopic guidance, it is more difficult to locate the common bile duct than during traditional open cholecystectomy. During the laparoscopic procedure the anatomy is distorted due to traction. The common duct, which carries bile from the liver and gallbladder to the intestine, may be mistaken for the cystic duct, which is closed off during cholecystectomy. In 418 laparoscopic cholecystectomies performed in a one-year period, intraoperative cholangiography was performed or attempted routinely with 90 percent success. There was one bile duct injury; this occurred early in the series. The use of routine intraoperative cholangiography is strongly recommended during laparoscopic cholecystectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abdomen, Laparotomy, Bile ducts, Biliary tract Radionuclide imaging

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