scholarly journals Clipless laparoscopic cholecystectomy: 3 Port access.

2020 ◽  
Vol 27 (06) ◽  
pp. 1124-1127
Author(s):  
Ghulam Hassan ◽  
Saad Gulzar ◽  
Tariq Iqbal ◽  
Mohammad Imranul Haque
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Harmonic Scalpel ◽  
Cystic Artery ◽  
Safe Alternative ◽  
Medical College ◽  
Post Operative Pain ◽  
Port Access ◽  
Electric Injury ◽  
Single Instrument

Objectives: Use to ultrasound vibrations instead of electric current makes Harmonic Scalpel a safer and more efficient instrument for dissection during laparoscopic surgeries. The property of both coagulation and cutting using single Harmonic Scalpel instruments saves time of surgery reducing anesthesia load. Cystic artery and liver bed dissection has been widely used and established but a contemporary approach is the coagulation and cutting of cystic duct with Harmonic Scalpel eliminating the need for clips and reducing the epigastric port size from 10mm to 5mm thus reducing post-operative pain. Study Design: Prospective Study. Setting: This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Period: Dec, 2015 to Dec, 2017. Material & Methods: 60 patients undergoing laparoscopic cholecystectomy 3 ports were introduced one 10mm and two 5mm. the dissection and division of both cystic artery and duct was done by a single instrument, Harmonic Scalpel after tying the cystic duct with 2/0 extracorporeal knot. Results: None of the patients developed Major or Minor bile leaks or hemorrhage. Conclusion: Harmonic scalpel provides a safe alternative for dissecting and division of cystic duct and may replace the more widely used clip technique. The number of ports can be reduced to 3 and size reduced from 10mm to 5 mm. Harmonic scalpel technique eliminates the time wasted during changing of instruments per-operatively and also reduces the risk of remote electric injury.

scholarly journals Is suture ligation of cystic duct in laparoscopic cholecystectomy a safe alternative to clipping? Our experience in a rural centre

2019 ◽  
Vol 6 (10) ◽  
pp. 3715
Author(s):  
K. R. Manoj Prabu ◽  
Dhinesh Balaji ◽  
Vishwanath M. Pai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Cystic Duct ◽  
Operating Time ◽  
Cost Effective ◽  
Safe Alternative ◽  
Suture Ligation ◽  
Medical College ◽  
The Mean ◽  
Mean Time

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. It remains an enigma regarding efficacy, safety and postoperative complications for using suture ligation for ligating cystic duct in laparoscopic cholecystectomy. The aim of the present study was to study the efficacy of ligating the cystic duct with sutures in laparoscopic cholecystectomy.Methods: This prospective study was performed between June 2018 and April 2019 in Saveetha Medical College and Hospital, in a rural center, Kanchipuram, India. All the patients included consented for the study. Patients who underwent subtotal cholecystectomy were excluded from the study.Results: The study included 70 patients who underwent laparoscopic cholecystectomy in a single unit. All cases were operated by a single surgeon. Of the 70 patients, the Cystic duct (CD) was simply ligated in 55 patients with CD <5 mm in diameter. The CD in 15 of those patients had to be divided and sutured in continuity for wide CD (>5 mm). The mean time for ligation of cystic duct was 5 min. Similarly, the mean time for ligation of cystic artery was 1.50 min. The mean operative time was 50 mins. There were no postoperative complications, such as bile leakage.Conclusions: SL of the CD is a very safe and secure alternative to the application of metal clips. It can be used in dilated CD, readily available and very cost effective and the complications of clips are avoided. The only disadvantage is that it needs expertise to perform and subsequently increasing the operating time. This technique is recommended in all laparoscopic cholecystectomies, especially in difficult cases.

Variations of Cystic Duct and Its Clinical Significance

2021 ◽  
Vol 9 (4) ◽  
pp. 8120-8126
Author(s):  
K. Sangameswaran ◽  
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Cystic Artery ◽  
Normal Anatomy ◽  
Biliary Anatomy ◽  
Medical College ◽  
Gallbladder Surgery ◽  
The Common ◽  
Common Problems

Background: Cystic duct drains the bile from the gallbladder into the common bile duct. Gallstone disease is one of the most common problems affecting the digestive tract and may lead to many complications. To avoid the complications in these patients the gallbladder is removed surgically (Cholecystectomy). Ligation of cystic duct and cystic artery is a prerequisite procedure when cholecystectomy is done. Understanding about the normal anatomy & the possible variations in biliary ductal system is important for the surgeons for doing cholecystectomy surgery successfully. Errors during gallbladder surgery commonly result from failure to appreciate the common variations in the anatomy of the biliary system. Aim of the study: To find out the incidence of variations in the length, course, and termination of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamilnadu. Meticulous dissection was done in the hepatobiliary system of these cadavers. Observations: During the study variations in the length of cystic duct, course and different modes of insertion of cystic duct were observed. Conclusion: Knowledge of variations in the length of cystic duct and knowing about different modes of course & insertion of cystic duct is necessary for surgeons while conducting cholecystectomy. The risk of iatrogenic injury is especially high in cases where the biliary anatomy is misidentified prior to surgery. KEY WORDS: Cystic duct, Gallbladder, Cholecystectomy.

scholarly journals Cystic vein: a guide for safer laparoscopic cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3238
Author(s):  
Debasish Samal ◽  
Rashmiranjan Sahoo ◽  
Sujata Priyadarsini Mishra ◽  
Krishnendu B. Maiti ◽  
Kalpita Patra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Anatomic Landmark ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Constant Feature ◽  
The Relationship

Background: Major complications of laparoscopic cholecystectomy are bleeding and bile duct injury, and it is necessary to clearly identify structures endoscopically to keep bleeding and injury from occurring. The aim of this study was to depict the anatomic landmark in the Calots triangle, a vein (cystic vein), a constant feature which can help Laparoscopic surgeons to conduct a safe LC along with other precautions to be adopted. Methods: A total of 100 patients (58 male, 42 female) who underwent cholecystectomy were examined preoperatively by clinically. The origin and number of cystic veins and their relationship with the Calot triangle was evaluated. Results: The cystic veins were delineated intraoperatively in 80 of the 93 patients. The relationship between the cystic vein and the Calot triangle was identified in 80 (86.02%) of the 93 patients. One cystic vein was found in 53 (66.25%) patients, while multiple cystic veins were found in 27 (33.75%) patients. All these veins are above the cystic common bile duct junction. Conclusion: The configuration of the cystic veins and their relationship in the Calot triangle with cystic artery and cystic duct can be identified intraoperatively and used as a guideline for safe laparoscopic cholecystectomy. 

scholarly journals CYSTIC ARTERY VARIATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY

1969 ◽  
Vol 6 (1) ◽  
pp. 714-717
Author(s):  
MUHAMMAD HUSSAIN ◽  
ADNAN BADAR ◽  
MANZOOR ALI ◽  
SHAHID ALAM ◽  
NAIK ZADA ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Hepatic Artery ◽  
Cystic Duct ◽  
Gold Standard ◽  
Cystic Artery ◽  
Common Hepatic Artery ◽  
Hepatic Parenchyma ◽  
Right Hepatic Artery ◽  
Calot’S Triangle

BACKGROUND: Lap cholecystectomy is gold standard for cholelithiasis. Earlier the incidence ofmorbidity and mortality was higher. Later on with the understanding of anatomy and fine techniquesboth morbidity and mortality decreased. Understanding of the anatomy of calot’s triangle reduces thecomplications of the procedure.OBJECTIVE: To study the pattern of variations in cystic artery and comparison with Caucasians.MATERIAL AND METHODS: All laparoscopic cholecystectomies performed in Shah MedicalCentre,over a period of 1 year from January 2013 to December 2013,in whom detailed anatomy ofcalot’s triangle was clearly displayed were included in the study. Those laparoscopic cholecystectomiesin whom the detailed anatomy was not clear were excluded from the study.Laparoscopic cholecystectomies were performed under general anesthesia. The anatomy of cystic arteryand its branches were identified, and it was also correlated in relation to cystic duct and common hepaticduct.We performed 240 lap cholecystectomies over a period of 1 year from January 2013 to December 2013.RESULTS: The pattern of cystic artery was studied in 240 laparoscopic procedures. Origin of cysticartery from right hepatic artery was observed in 82% cases. Double cystic arteries were observed in 8%cases. Common hepatic artery gave rise to 6% cystic arteries. Cystic arteries originated fromgastroduodenal artery in 3% cases. Hepatic parenchyma gave rise to 2% cases.CONCLUSION: Percentage of variations in cystic artery as compared to Caucasians are not different inour study.These variations should be kept in mind to reduce complications.KEYWORDS: laparoscopic cholecystectomy, calot’s triangle, hepatic artery, cystic artery.

scholarly journals Artery to Cystic Duct: A Consistent Branch of Cystic Artery Seen in Laparoscopic Cholecystectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Arshad Rashid ◽  
Majid Mushtaque ◽  
Rajandeep Singh Bali ◽  
Saima Nazir ◽  
Suhail Khuroo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Branching Pattern ◽  
Accurate Identification ◽  
Calot’S Triangle ◽  
Arterial Bleeding ◽  
Bile Duct Damage

Uncontrolled arterial bleeding during laparoscopic cholecystectomy is a serious problem and may increase the risk of bile duct damage. Therefore, accurate identification of the anatomy of the cystic artery is very important. Cystic artery is notoriously known to have a highly variable branching pattern. We reviewed the anatomy of the cystic artery and its branch to cystic duct as seen through the video laparoscope. A single artery to cystic duct with the classical “H-configuration” was demonstrated in 161 (91.47%) patients. This branch may cause troublesome bleeding during laparoscopic dissection in the hepatobiliary triangle. Careful identification of artery to cystic duct is helpful in the proper dissection of Calot’s triangle as it reduces the chances of hemorrhage and thus may also be helpful in prevention of extrahepatic biliary radical injuries.

Optimizing the critical view of safety in laparoscopic cholecystectomy by clipping and transecting the cystic artery before the cystic duct

2007 ◽  
Vol 94 (4) ◽  
pp. 473-474 ◽  
Author(s):  
A. R. Wijsmuller ◽  
M. Leegwater ◽  
L. Tseng ◽  
H. J. Smaal ◽  
G. J. Kleinrensink ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Critical View ◽  
Critical View Of Safety

scholarly journals Triangle of Safety Technique: A New Approach to Laparoscopic Cholecystectomy

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Abdulrahman F. M. S. Almutairi ◽  
Yousef A. M. S. Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Operating Time ◽  
Gallbladder Wall ◽  
Cystic Artery ◽  
Safe Procedure ◽  
Calot’S Triangle ◽  
Safety Technique ◽  
Delayed Complications ◽  
Cbd Injury

Backgrounds and Study Aims. Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy (LC). Misidentification of the CBD during dissection of the Calot's triangle can lead to such injuries. The aim of the authors in this study is to present a new safe triangle of dissection. Patients and Method. 501 patients under went LC in the following approach; The cystic artery is identified and mobilized from the gall bladder (GB) medial wall down towards the cystic duct which would simultaneously divide the medial GB peritoneal attachment. This is then followed by dividing the lateral peritoneal attachment. The GB will be unfolded and the borders of the triangle of safety (TST) are achieved: cystic artery medially, cystic duct laterally and the gallbladder wall superiorly. The floor of the triangle is then divided to delineate both cystic duct and artery in an area relatively far from CBD. Results. There were little significant immediate or delayed complications. The mean operating time was 68 minutes, nearly equivalent to the conventional method. Conclusions. Dissection at TST appears to be a safe procedure which clearly demonstrates the cystic duct and may help to reduce the CBD injuries.

scholarly journals Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

2017 ◽  
Vol 5 (12) ◽  
pp. 5145
Author(s):  
Anand Vijayvargiya ◽  
S. K. Jain ◽  
Varsha Soni
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Hospital Stay ◽  
Cystic Duct ◽  
Harmonic Scalpel ◽  
P Value ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Duration Of Surgery

Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.

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