Recommendation for Photographic Documentation of Safe Laparoscopic Cholecystectomy

Abstract Background Bile duct injury and vasculobiliary injury are possible complications during laparoscopic cholecystectomy which can lead to increased morbidity, mortality, costs of hospitalization and litigation. Proper documentation of the critical view of safety and safe plane of dissection may play a crucial role for archivization, teaching and medicolegal purposes. Methods The study group consisted of 100 patients with symptomatic cholecystolithiasis qualified for laparoscopic cholecystectomy. The critical view of safety was documented on two photographs and safe plain of dissection obtained with laparoscopic ultrasound was documented on one photograph as well as the whole procedure was recorded. The photographs were printed in the operating theatre and videos were stored on an external hard drive. Results The mean time to obtain and analyse photographs was significantly shorter than video, and the size of the stored data was significantly smaller for photographs than videos. The cost of one documentation procedure was significantly lower for video than photographs. Critical view of safety was obtained in 91 patients, and laparoscopic ultrasound was successful in 99 patients. The conversion rate was 2%, and fundus-first cholecystectomies were performed in 6% of patients. We did not observe any biliary and vascular complications. Conclusions Photographic documentation of the critical view of safety and safe plane of dissection should be an inherent part of laparoscopic cholecystectomy. Our proposal of documentation prepared in the operating theatre and stored in the patient’s documentation is an example of an easy, fast and cheap method of data archivization.

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Navigation with laparoscopic ultrasound during fundus-first laparoscopic cholecystectomy-a single-centre retrospective case control study

10.21203/rs.3.rs-60946/v1 ◽

2020 ◽

Author(s):

Maciej Sebastian ◽

Agata Sebastian ◽

Jerzy Rudnicki

Keyword(s):

Laparoscopic Cholecystectomy ◽

Statistical Significance ◽

Laparoscopic Ultrasound ◽

Retrospective Case ◽

Exact Test ◽

Critical View ◽

Critical View Of Safety ◽

The Mean ◽

Mean Time ◽

Bail Out

Abstract Background Laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystolithiasis. The critical view of safety is a generally accepted technique of intraoperative visualization but during inflammation and fibrosis in the region of Calot’s triangle it may fail. Fundus-first laparoscopic cholecystectomy with laparoscopic ultrasound navigation may be an attractive bail-out option when the intraoperative conditions are difficult. Methods The study group consisted of 900 patients with symptomatic cholecystolithiasis which was divided into two subgroups. The first subgroup where the only method of intraoperative identification was the critical view of safety consisted of 402 patients, the second subgroup where the critical view of safety and laparoscopic ultrasound were used consisted of 498 patients. In the first subgroup fundus-first laparoscopic cholecystectomy was performed in 13 patients, in the second subgroup in 42 patients. Statistical analysis included the Mann-Whitney U test for continuous and Fisher’s exact test for binary variables. The level of statistical significance was set at 95% (p < 0.05). Results Fundus-first technique was significantly more often in the subgroup with laparoscopic ultrasound and the hospitalization time of fundus-first laparoscopic cholecystectomies was significantly shorter than in converted cases. The mean time of laparoscopic cholecystectomy and the mean time to obtain the transection level between the gallbladder and the hepatoduodenal ligament were significantly shorter and the conversion rate was significantly lower in the fundus-first and laparoscopic ultrasound group. Conclusions Fundus-first technique with laparoscopic ultrasound navigation may be a very efficient bail-out option during laparoscopic cholecystectomy due to a more precisely and significantly faster defined plane of dissection what enables safe performance of laparoscopic cholecystectomy with significantly lower rate of conversions.

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