Retroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson’s capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson’s capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case–control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson’s capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P = 0.027 and 0.017, respectively). CONCLUSIONS Glisson’s capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

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Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195007 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4310

Author(s):

Kirti Savyasacchi Goyal ◽

Maneshwar Singh Utaal ◽

Pramod Kumar Bhatia

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Operative Time ◽

Gall Bladder Disease ◽

Single Incision ◽

Intraoperative Complications ◽

Single Incision Laparoscopic Surgery ◽

Bladder Disease ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of 25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.

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Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: An argument for the single incision approach?

Minimally Invasive Therapy & Allied Technologies ◽

10.3109/13645706.2014.980430 ◽

2014 ◽

Vol 24 (3) ◽

pp. 175-180 ◽

Cited By ~ 2

Author(s):

Philippe M. Glauser ◽

Samuel A. Käser ◽

Simeon Berov ◽

Mikolaj Walensi ◽

Evelyn Kuhnt ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Incision ◽

Umbilical Incision ◽

Standard Laparoscopic Cholecystectomy

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Single-Incision Laparoscopic Cholecystectomy: A Combined Analysis of Resident and Attending Learning Curves at a Single Institution

The American Surgeon ◽

10.1177/000313481207800148 ◽

2012 ◽

Vol 78 (1) ◽

pp. 119-124

Author(s):

Mark Joseph ◽

Michael Phillips ◽

Christopher C. Rupp

Keyword(s):

Laparoscopic Cholecystectomy ◽

Learning Curve ◽

Single Incision ◽

Learning Curves ◽

Patient Specific ◽

Short Learning Curve ◽

Significant Difference ◽

Surgeon Experience ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic programs. We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed into cohorts of 25 based on teaching surgeon experience. Data recorded included patient-specific and operative variables along with complications, conversion to standard laparoscopic cholecystectomy, and outcomes. One hundred one patients underwent SILC. Twelve per cent of patients required conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times compared within the experience-based cohorts ( P = 0.21). A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy (SLC) along their learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications and outcomes similar to SLC with preservation of operative efficiency and safety. Further studies are warranted, however, at a national/international level to define the place and use for SILC as well as the incorporation of single-incision techniques into resident curriculum.

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