Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient

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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Comparison of low and standard pressure gas injection at abdominal cavity on post operative nausea and vomiting in laparoscopic cholecystectomy

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.305.5010 ◽

1969 ◽

Vol 30 (5) ◽

Cited By ~ 1

Author(s):

Reza Akhondzadeh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Cavity ◽

Gas Injection ◽

Nausea And Vomiting ◽

Standard Pressure ◽

Post Operative Nausea

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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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Metastasis of missed cholangiocarcinoma in the left lobethrough abdominal wall laparoscopic port-site and umbilicus after laparoscopic cholecystectomy: case report and literature review

10.21203/rs.3.rs-45597/v1 ◽

2020 ◽

Author(s):

Lesheng Huang ◽

Hongyi Li ◽

Jun Chen ◽

Jinghua Jiang ◽

Wanchun Zhang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Wall ◽

Malignant Tumor ◽

Malignant Tumors ◽

Abdominal Cavity ◽

Left Lobe ◽

Port Site ◽

Laparoscopic Port ◽

Missed Diagnosis ◽

Upper Abdominal

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been widely used by surgeons. However, a serious but rare condition may be happened, which is the missed diagnosis of intraperitoneal malignant tumor. If the malignancy exists, the changes of the abdominal environment or the laparoscopic operation might brought the cancer cells to the abdominal cavity or the abdominal wall. The missed laparoscopic malignant tumors are prone to metastasis, especially at the laparoscopic port-site. More extreme condition will be located in the navel, which is known as Sister Mary Joseph’s nodule(SMJN).Case presentation: A 63-year-old female who had undergone cholecystectomy and choledocholithotomy ten months ago was hospitalized for upper abdominal pain. Laboratory examination indicated that the most of tumor markers were increased. CT scan revealed that there was a diffused irregular and progressively enhanced mass around the left lobe bile duct, multiple enlarged lymph nodes in the abdominal cavity and multiple nodular lesions were found under the costal margin of the right upper abdominal wall, right lower abdominal wall and the umbilicus. Biopsy of the nodules under the original surgical scar showed an infiltrative or metastatic middle differentiated adenocarcinoma. So the diagnosis was left lobe cholangiocarcinoma of the liver, multiple lymph nodes metastasis in the abdominal cavity and multiple implant metastasis in abdominal wall laparoscopic port-site and umbilical.Conclusion: In laparoscopic cholecystectomy, surgeons should not only focus on the local lesions, like gallstone in biliary system, but also look around other the tissues and organs to avoid missing the abdominal malignant tumor or other lesions. When atypical symptoms or abnormalities have been found pre-operation, all abdominal organs should be evaluated in detail to avoid missed diagnosis of potential malignant tumors. On the other hand, when there is a nodule in the umbilicus, all the organs and tissues in abdomen should be examined to find the potential malignant tumor. Finally, multiple cholelithiasis in the left lobe of the liver should be regarded as a high risk factor for cholangiocarcinoma.

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Intraperitoneal Granulomas Unexpectedly Found during a Cesarean Delivery: A Late Complication of Dropped Gallstones

Case Reports in Pathology ◽

10.1155/2017/4873273 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

David A. Suarez-Zamora ◽

Luis E. Barrera-Herrera ◽

Ricardo Caceres-Mileo ◽

Mauricio A. Palau-Lazaro

Keyword(s):

Laparoscopic Cholecystectomy ◽

Foreign Body ◽

Cesarean Delivery ◽

Histological Examination ◽

Abdominal Cavity ◽

Late Complication ◽

Body Type ◽

Neoplastic Tissue ◽

Interpretation Errors ◽

Granulomatous Response

Laparoscopic cholecystectomy is the treatment of choice for patients with symptomatic cholelithiasis. Spillage of gallstones into the abdominal cavity during laparoscopic cholecystectomy occurs in approximately one-third of cases. Although retained gallstones remain asymptomatic, few cases may develop complications. We report the case of a 29-year-old nulliparous woman presenting with several hard nodules in the omentum, raising the possibility of a metastatic disease. Histological examination demonstrated a bile-stained material and a foreign body-type granulomatous response without neoplastic tissue. Our case demonstrates an example of a complication resulting two years after a laparoscopic cholecystectomy that was unexpectedly found during a cesarean delivery. Pathologists should be aware of this entity to avoid interpretation errors.

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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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Characterisation of trocar associated gas leaks during laparoscopic surgery

Surgical Endoscopy ◽

10.1007/s00464-021-08807-1 ◽

2021 ◽

Author(s):

Daniel Robertson ◽

Frank Sterke ◽

Willem van Weteringen ◽

Alberto Arezzo ◽

Yoav Mintz ◽

...

Keyword(s):

Health Hazard ◽

Abdominal Cavity ◽

Surgical Instruments ◽

Potential Health ◽

Surgical Smoke ◽

Associated Gas ◽

Laparoscopic Equipment ◽

Potential Health Hazard ◽

Surgical Teams ◽

Gas Leaks

Abstract Background During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO2) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures. Methods A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery. Results Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage. Conclusions We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO2 leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.

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Choice of tactics of surgical treatment of acute cholecystitis and its complications

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(3)-08 ◽

2018 ◽

Vol 22 (3) ◽

pp. 442-445

Author(s):

B.S. Zaporozhchenko ◽

K.V. Kravets ◽

I.E. Borodaev ◽

D.A. Bondarets ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Average Duration ◽

Abdominal Cavity ◽

Age Groups ◽

Total Duration ◽

Duration Of Treatment ◽

Surgical Interventions ◽

Emergency Operations ◽

Surgical Tactics

Acute cholecystitis ranks second in the incidence of urgent surgical diseases in hospitals in Ukraine. Despite a marked improvement in the treatment results, the lethality after emergency operations (9,4-37%) for acute cholecystitis complicated by peritonitis remains several times higher than with routine surgical interventions. Objectives — development of rational surgical tactics and evaluation of the effectiveness of treatment of acute cholecystitis and its complications in patients of different age groups, with different pathomorphological forms of acute cholecystitis. The result of treatment of 203 patients was presented: 75 (37,5%) were operated on an emergency basis, 73 (36,5%) urgently, and 52 (26%) in a deferred period. 173 (86.5%) patients were operated using laparoscopic technologies. Intraoperative cholangiography was performed in 16 (9,3%) patients during laparoscopic interventions. In 17 (8,5%) patients, “open” operations were performed. All patients underwent drainage of the abdominal cavity with one or more drains in view of the presence of peritonitis. The average duration of the preoperative period was 1.5 days, the total duration of treatment with LC was 4.5 days, and the total duration of treatment with OC was 10.8 days. So, in the early stages of the development of acute cholecystitis, laparoscopic cholecystectomy is effective. The use of lifting systems for laparoscopic cholecystectomy is advisable in elderly and senile patients, with concomitant diseases of the heart and lungs.

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Features of laparoscopic hernioplasty of paracolostomy hernias in patients with combined abdominal pathology

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(4)-07 ◽

2020 ◽

Vol 24 (4) ◽

pp. 600-603

Author(s):

K. Yu. Parkhomenko

Keyword(s):

Laparoscopic Cholecystectomy ◽

Average Length ◽

Abdominal Cavity ◽

Surgical Interventions ◽

Surgical Department ◽

Inguinal Hernias ◽

Laparoscopic Hernioplasty ◽

Commercial Enterprise ◽

Laparoscopic Techniques ◽

Ventral Hernias

Annotation. The aim of the study is to study the technological features and results of simultaneous laparoscopic hernioplasty of paracolostomy hernias in the presence of combined abdominal pathology. We analyzed the results of surgical treatment of 11 patients with paracolostomy hernias who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council “Regional Clinical Hospital” from 2016 to 2020, of whom – women – 4 (36%), men – 7 (64%), aged from 42 to 69 years old. Clinical, anamnestical and instrumental data for the prolongation of cancer were not identified in all patients. Out of 11 patients, in addition to paracolostomy hernia, 3 (27%) had inguinal hernias, 8 (73%) had postoperative ventral hernias. 3 (27%) patients with hernias also had cholecystolithiasis. All patients underwent laparoscopic hernioalloplasty of paracolostomy hernia. 3 patients underwent simultaneous TAPP for inguinal hernias, and 1 patient underwent laparoscopic cholecystectomy and TAPP. 6 patients with incisional ventral hernias underwent simultaneous IPOM according to the standard method, and 2 – according to the own method. Of the above, 2 patients suffering from cholecystolithiasis, in addition to hernioalloplasty, underwent laparoscopic cholecystectomy. In 4 (36%) patients, viscerolysis was additionally performed due to the presence of an adhesive process in the abdominal cavity. Simultaneous hernioalloplasty TAPP and IPOM, as well as laparoscopic cholecystectomy, had no significant effect on the development of complications and the duration of hospitalization. The average length of inpatient treatment was 9.2 bed-days. The study proves the expediency of widespread simultaneous surgical interventions for hernias of the anterior abdominal wall, as well as the preference for laparoscopic techniques.

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Prophylaxis and correction of complications while performance of a monoport laparoscopic cholecystectomy for chronic calculous cholecystectomy

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2018.06.27 ◽

2018 ◽

Vol 85 (6) ◽

pp. 27-29

Author(s):

B. S. Kravchenko

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Cavity ◽

Drainage Tube ◽

Port Access ◽

Prophylactic Measures ◽

Transumbilical Access ◽

Calculous Cholecystitis

Objective. To analyze the causes and rates of perioprative complications and to estimate the methods of their correction while performance of a monoport laparoscopic cholecystectomy (LCH) for chronic calculous cholecystitis (CHCH). Маterials and methods. In the period of 2015 - 2017 yrs in 102 patients a monoport LCH for CHCH was performed. Results. In all the patients a standard monoport cholecystectomy was performed, using laparoscopic transumbilical access. In 12 patients a necessity for additional 5-mm trocar have occurred, in 2 - a necessity for conversion (pass towards the four-port access in cholecystectomy). In 11 patients the abdominal cavity drainage via additional (5 mm) access was done, in 3 the liquid accumulations were revealed in zone of the gallbladder vesicle bed. In 1 a drainage tube was inserted and endoscopic papillosphincterotomy was performed. Conclusion. A monoport access for performance of cholecystectomy may be applied in patients with uncomplicated course of CHCH. Possible complications, occurring while application of a monoport access, may be predicted and addressed by prophylactic measures.

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