Laparoscopic surgery produced less surgical smoke and contamination comparing with open surgery: the pilot study in fresh cadaveric experiment in COVID-19 pandemic

Abstract Background The SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers. Methods Cholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared. Results Open cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 μm and particle sizes ≥ 5 μm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001. Conclusions Laparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.

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THE CONVERSION TO OPEN SURGERY IN LAPAROSCOPIC CHOLECYSTECTOMY

Journal of Surgical Sciences ◽

10.33695/jss.v1i2.174 ◽

2018 ◽

Vol 1 (2) ◽

pp. 57-61

Author(s):

I. Slavu ◽

V. Braga ◽

L. Alecu

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Retrospective Study ◽

Gold Standard ◽

Preoperative Diagnosis ◽

Open Surgery ◽

Open Cholecystectomy ◽

Safe Method ◽

Conversion To Open Surgery ◽

Conversion To Open Cholecystectomy

After more than 20 years from the beginning of laparoscopic surgery, laparoscopic cholecystectomy still holds a conversion rate of 5.1 % in the specialty literature. We have conducted a retrospective study based on the experience of the clinical unit of General Surgery within “Prof. Dr. A. Ionescu” Emergency Clinical Hospital, between 1997 and 2013. A number of 2,309 laparoscopic cholecystectomies were performed. The average age of the group was 47.3 years. Conversion was performed to a number of 58 patients (2.51%), out of which 74.13% women (no. = 43) and 26% men (no. 15). The average age of the patients to whom the conversion was performed was 57. Conversion to open cholecystectomy was more frequent in patients over 60 (no. 38). The main preoperative diagnosis in converted patients was acute lithiasic cholecystitis. Laparoscopic cholecystectomy is a safe method with optimal results, being considered the “gold standard” in the treatment of bladder lithiasis. Conversion to open surgery is an expression of the surgeon’s experience and wisdom.

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THE STUDY OF CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS.

10.36106/paripex/7101615 ◽

2019 ◽

pp. 1-3

Author(s):

Dug Tariq Hassan ◽

Rayees Ahmad Bhat ◽

Liyaqat Nazir ◽

Shabir Ahmad Dar ◽

Mohammad Zakiuddin

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Open Cholecystectomy ◽

Medical Sciences ◽

Preoperative Risk ◽

Conversion To Open Surgery ◽

Preoperative Risk Factors ◽

Risk Scoring

BACKGROUND: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion.However,there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints,which is a significant problem in developing countries. AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting. MATERIALS AND METHODS:A case control study of patients who underwent laparoscopic surgery from May 2016 to April 2017 at Shere Kashmir Institute of Medical Sciences, Srinagar. All those patients who were converted to open surgery (n = 73) were enrolled as cases.Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery. RESULTS:The final multivariate model identified two risk factors for conversion:ultrasonography signs of inflammation (adjusted odds ratio [aOR] = 8.5;95% confidence interval [CI]:3.3,21.9) and age > 60 years (aOR = 8.1;95% CI:2.9,22.2) after adjusting for physical signs,alkaline phosphatase and BMI levels. CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion

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Evaluation of predictive factors for conversion of laparoscopic cholecystectomy

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i1.1761 ◽

1970 ◽

Vol 7 (1) ◽

pp. 26-30 ◽

Cited By ~ 5

Author(s):

R Gabriel ◽

S Kumar ◽

A Shrestha

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Predictive Factors ◽

Open Cholecystectomy ◽

Abdominal Cavity ◽

Bladder Wall ◽

Patient Factors ◽

College Hospital ◽

Biliary Pain ◽

Conversion Rates

Background: Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder diseases. However, certain cases still require conversion to open procedures. This study identifies and evaluates risk factors that may predict conversion from laparoscopic to an open procedure. Objectives: To identify and evaluate the predictive factors for conversion of laparoscopic to open cholecystectomy. Materials and methods: A total of 234 Laparoscopic cholecystectomies were attempted at the Kasturba Medical College Hospital, Manipal, from January 2003 to July 2005. Of these, 61 had to be converted to open cholecystectomy. A retro and prospective analysis of different parameters, including Patient factors, Intra-operative factors and Surgeon factors were performed. Results: Sixty one (26.1%) laparoscopic cholecystectomies required conversion. Factors contributing to conversion included male sex, age group of 31-40 years, over weight and history of biliary pain within last two to four months, ultrasonography findings of multiple calculi and gall bladder wall thickness of more than 3 mm. Intraoperative gall bladder perforation with spillage of its contents in abdominal cavity and dense adhesions with difficult anatomy resulted in higher conversion rates. Surgery performed by surgeons in learning phase of laparoscopic surgery was more prone to conversion. Conclusion: Patient factors, presentation, preoperative ultrasonography findings and surgeon's experience, all contribute to the possibility of conversion of laparoscopic cholecystectomy. Knowledge of these factors may help in preinformation to patient for psychological preparations for conversion and an experienced surgeon can plan to operate on these patients. Key words: Cholecystectomy, laparoscopy, conversion. doi: 10.3126/kumj.v7i1.1761 Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 26-30

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A prospective evaluation of laparoscopic cholecystectomy in the treatment of chronic cholelithiasis: A five-year experience

Medicinski pregled ◽

10.2298/mpns1102077s ◽

2011 ◽

Vol 64 (1-2) ◽

pp. 77-83

Author(s):

Veselin Stanisic ◽

Milorad Bakic ◽

Milorad Magdelinic ◽

Hamdija Kolasinac ◽

Darko Vlaovic ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Lower Cost ◽

Average Duration ◽

Open Cholecystectomy ◽

Abdominal Cavity ◽

Safe Procedure ◽

Conversion To Open Cholecystectomy ◽

Duration Of Hospitalization ◽

Calculous Cholecystitis ◽

Gallbladder Removal

Introduction. Laparoscopic cholecystectomy is a method of choice in the treatment of symptomatic cholecystolithiasis because of less postoperative pain, shorter hospitalization and lower cost of treatment. The study was aimed at analysing the outcome of laparoscopic cholecystectomy in patients surgically treated for chronic calculous cholecystitis (symptomatic cholelithiasis). Material and methods. The research was done in the period from December 2003 to December 2008. In the prospective study of 386 patients, we analyzed operative and postoperative complications, the reasons for conversion to open cholecystectomy, duration of hospitalization and mortality. Results. The average duration of laparoscopic cholecystectomy was 31.9?14.5 min: dissection of adhesions 3.2?0.7 min., elements of Calot?s triangle 9.8?3.2 min., gallbladder releasing from its bed 12.8?2.8 min., the abdominal cavity lavage and removal of gall?bladder from the abdomen 6.8?0.9 min. Some operative difficulties emerged in 22 (5.7%) patients - 4 (1%) during releasing of gallbladder adhesions from the surrounding structures, 9 (2.3%) during dissection of elements of the Calot?s triangle, 6 (1.5%) during gallbladder releasing from its bed, 3 (0.7%) during gallbladder removal from the abdomen. Some post-operative complications, single or associated, occurred in 36 (9.3%) patients: perforation of gallbladder 21 (5.4%), bleeding from gallbladder bed 18(4.6%)/, injury of extra hepatic bile ducts 1 (0.2%), 9 (2.3%) spillage of stones; 3 (0.7%) conversions were made. The average duration of preoperative and postoperative hospitalization was 1.1?0.3 and 1.4?0.5 days, respectively. The pathohistological examination revealed 2 (0.5%) adenocarcinoma of gallbladder. There were no lethal outcomes. Conclusion. Laparoscopic cholecystectomy is a safe procedure and rational choice in the treatment of biliary dyskinesia and symptomatic biliary calculosis with an acceptable rate of conversion.

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Comparative Study of the Effect of Laparoscopic and Open Surgery on Acute Cholecystitis

Advanced Emergency Medicine ◽

10.18686/aem.v4i3.8 ◽

2015 ◽

Vol 4 (3) ◽

pp. 23

Author(s):

Jian Lin

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Open Surgery ◽

Open Cholecystectomy ◽

Operation Time ◽

Surgical Indications ◽

Method Clinical Data ◽

Function Recovery ◽

Stay Time ◽

Strict Condition

Objective: To compare the clinical effect of laparoscopic and open surgery on acute cholecystitis. Method: clinical data of 200 cases of acute cholecystitis patients in our hospital from July 2006 to July 2010 were divided into laparoscopic cholecystectomy(LC) group and open cholecystectomy(OC) group. Comparison was made from various aspects to show the feasibility of laparoscopic cholecystectomy of acute cholecystitis. Results: the operation time, off-bed activity time, postoperative gastrointestinal function recovery time and hospital stay time of LC group were all lower than OC group (t = 2.785, t = 2.825, t = 2.831, t = 2.904, p < 0.05); OC group’s postoperative complications was 23.0%, higher than that (9.0%) of LC group(χ2 = 3.764, p < 0.05). Conclusion: Under the chosen strict condition of surgical indications and delicate surgery operation, the application of laparoscopic cholecystectomy in the treatment of acute cholecystitis is safe and feasible.

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Risk factors for the conversion of laparoscopic to open cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20182487 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2470

Author(s):

Kiran Kumar Paidipelly ◽

Sangamitra .

Keyword(s):

Laparoscopic Cholecystectomy ◽

Open Surgery ◽

Open Cholecystectomy ◽

Previous History ◽

Normal Activity ◽

Post Surgery ◽

History Of ◽

The Right ◽

Hospital Days ◽

Lower Morbidity

Background: Gall stones is one of the most common diseases in man. Laparoscopic cholecystectomy is the preferred procedure, mainly due to lower morbidity and mortality, thus returning to the normal activity sooner, lesser number of hospital days and lesser pain post-surgery. However, around 2-15% of the patients need to convert from laparoscopic to open surgery due to different reasons.Methods: 357 patients who came in for laparoscopic cholecystectomy were included into the study. Details such as age, height, weight, BMI, mode of surgery i.e. emergency or elective, physical and clinical examination including Ultrasound, lab results, previous history of surgery and other co morbidities were noted.Results: Out of the 357 patients, 31(8.7%) were converted to open cholecystectomies, of which, 61.3% females and 38.7% males. 58% in the open cholecystectomy group were above 60 years. 67.7% of the patients who converted to open surgery had a BMI of over 25, while it was 39.6% in case of laparoscopic surgery. 74.2% among the patients who had undergone conversion to the open surgery had pain in the right hypochondrium, 67.7% had increased WBC levels.Conclusions: Increased age, obesity, tenderness in the RHC, increased WBC levels, acute cholecystitis are the predisposing factors for the conversion of laparoscopic cholecystectomy to open cystectomy.

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Role of Laparoscopic Surgery in the Current Management of Mirizzi Syndrome

The American Surgeon ◽

10.1177/000313481808400517 ◽

2018 ◽

Vol 84 (5) ◽

pp. 667-671 ◽

Cited By ~ 2

Author(s):

Rondi Gelbard ◽

Desmond Khor ◽

Kenji Inaba ◽

Obi Okoye ◽

Crystal Szczepanski ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Open Cholecystectomy ◽

Disease Process ◽

Laparoscopic Approach ◽

Mirizzi Syndrome ◽

Open Approach ◽

Significant Difference ◽

Care Surgery

Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis caused by extrinsic biliary compression by stones in the gallbladder infundibulum or cystic duct. The purpose of this study was to evaluate the outcomes associated with a laparoscopic approach to this disease process. This is a 10-year, retrospective study conducted at two academic medical centers with established acute care surgery practices. Patients with a diagnosis of MS confirmed intraoperatively were included. Eighty-eight patients with MS were identified with 55 (62.5%) being type 1. Twenty six (29.5%) patients, all type 1, underwent successful laparoscopic cholecystectomy. Of the 62 patients that underwent open cholecystectomy, 27.3 per cent had a laparoscopy converted to open procedure. There was no significant difference in overall complications (19.2 vs 29%) among those undergoing laparoscopic versus open cholecystectomy. Length of stay was lower in patients that had a laparoscopic approach ( P = 0.001). Laparoscopic cholecystectomy can safely be attempted in type 1 MS and seems to be associated with fewer overall complications and shorter length of stay compared with an open approach.

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College and ALSGBI pioneer laparoscopic surgery courses

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363508x273506 ◽

2008 ◽

Vol 90 (2) ◽

pp. 48-49

Author(s):

Mark Coleman

Keyword(s):

Laparoscopic Cholecystectomy ◽

Minimally Invasive Surgery ◽

Laparoscopic Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Royal College ◽

Open Surgery ◽

Active Role ◽

Surgical Skills ◽

Previously Treated

Over the last two decades, minimally invasive surgery (MIS) has become the mainstream method for the treatment of many abdominal diseases previously treated by open surgery. It has resulted in improvements in many outcomes during and after surgery. The Royal College of Surgeons of England has always played an active role in training both consultant surgeons and trainees in minimally invasive surgery with courses such as the Intercollegiate Basic Surgical Skills Courses (BSS) and laparoscopic cholecystectomy courses run in the College itself and in regional units. Laparoscopic surgery itself presents unique challenges that demand that courses be designed specifically with these in mind.

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