An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery

Nasr, Mohamed Mahmood

doi:10.1007/s11605-016-3308-7

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…They used the inner lumen of the GB as a landmark to avoid vasculobiliary injury during cholecystectomy. Nasr [ 22 ] used an anatomical point which was the joining of the cystic artery and GB distal infundibulum as an anatomical landmark during fundus-first subtotal cholecystectomy to avoid serious vascular or biliary injury. This anatomical landmark, however, was vague and not always obvious, especially in difficult cases with severe adhesions.…”

Section: Discussionmentioning

confidence: 99%

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience

Badawy,

Fathi,

Sabra

2023

Cureus

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Introduction The critical view of safety is an important concept for safe laparoscopic cholecystectomy. However, no standard step-by-step approach for achieving the critical view of safety has been established until now. Therefore, this study aims to evaluate a new approach for achieving the critical view of safety using the diagonal line of liver segment IV as an anatomical landmark. Patients and methods In this prospective non-randomized study, patients (n= 112) who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis were included. The first 47 patients underwent laparoscopic cholecystectomy using the diagonal line approach (DLC group) whereas, the next 65 patients underwent laparoscopic cholecystectomy using the conventional method (CLC group). Results No significant difference between both groups regarding the preoperative characteristics, operative time, and intraoperative blood loss. Laparoscopic subtotal cholecystectomy was performed more in the DLC group (6% vs 0%, p= 0.07). Whereas, in the CLC group, there was a tendency towards conversion to open cholecystectomy in difficult cases (6% vs 2%, p= 0.40). No intra- or postoperative complications occurred in either group. Conclusion The diagonal line approach is a feasible and useful step-by-step technique to achieve the critical view of safety in laparoscopic cholecystectomy and enables surgeons to perform safe laparoscopic subtotal cholecystectomy in difficult cases.

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Section: Discussionmentioning

confidence: 99%

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience

Badawy,

Fathi,

Sabra

2023

Cureus

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“…Laparoscopic fundus‐first cholecystectomy involves dissecting the gallbladder off the liver bed in a retrograde manner, from the fundus to the infundibulum, until it hangs from the cystic structures [19]. It is a useful option, particularly in cases of chronic inflammation and severely contracted gallbladders, and can additionally be combined with subtotal cholecystectomy [47, 48]. However, it carries a relatively higher risk for bleeding, because the cystic artery has not been ligated, gallstone migration into the CBD during manipulation, and “extreme” vasculobiliary injuries if dissecting continues into the wrong plane [49].…”

Section: Discussionmentioning

confidence: 99%

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

et al. 2022

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Background The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives. Method We systematically reviewed the literature (1995–2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI). Results 150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail‐out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS‐related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors). Conclusion Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail‐out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.

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“…Resultados similares obtenidos por Hussien en el Hospital Walles de Belfast Nueva Irlanda, 24 Banz en la Universidad de Berna en Suiza 5 y Aziz en la Universidad de Arizona en los Estados Unidos de Norteamérica, 25 corroboran que entre mayor grado de obesidad mayor es el número de complicaciones; señalando también que, aunque la enfermedad es más frecuente en mujeres, las mayores complicaciones suelen presentarse en hombres; [26][27][28][29] recomendándose que en casos tan severos se puede realizar la colecistectomía subtotal en un afán de evitar la lesión de la vía biliar. [30][31][32][33] Los resultados de nuestro estudio confirman lo reportado en la literatura mundial, la colelitiasis fue más frecuente en el sexo femenino (84.21%) que en el masculino (15.79%) (p = 0.001), con un promedio de edad para todo el grupo de 45.78 ± 13.28 años e IMC de 32.87 ± 6.02 kg/m 2 . Aunque en 28.29% hubo comorbilidad asociada (hipertensión arterial, diabetes tipo 2, asma, cirrosis e insuficiencia venosa profunda en extremidades inferiores), ésta no constituyó un factor de riesgo importante en los resultados de la cirugía.…”

Section: Discussionunclassified

¿Influye la obesidad en la morbimortalidad de la colecistectomía laparoscópica?

Dietlen¹,

Morales²,

Bustamante³

et al. 2022

Cirujano General

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RESUMENIntroducción y objetivo: la colecistectomía es el tratamiento de elección de la litiasis vesicular, la cual no está exenta de complicaciones (2-5%) relacionadas con dominio de la técnica, inflamación del triángulo de Calot o variantes anatómicas. Recientemente se ha considerado la obesidad como un factor de riesgo, por lo que decidimos realizar el presente estudio en dos hospitales del sureste de México. Material y métodos: estudio prospectivo, multicéntrico, comparativo en pacientes sometidos a colecistectomía laparoscópica por cirujanos con más de 15 años de experiencia, clasificados en tres grupos: A) peso normal, B) sobrepeso y C) obesidad. Variables analizadas: características antropométricas, comorbilidades, tiempo quirúrgico, días/estancia, complicaciones y mortalidad. Análisis estadístico: los resultados fueron analizados mediante estadística descriptiva e inferencial, con el programa SPSS 24.0. Resultados: fueron sometidos a colecistectomía laparoscópica 317 pacientes. Grupo A: 134 casos, edad promedio 45.78 ± 14.6 años, mujeres 83.58%, índice de masa corporal (IMC) 22.6 ± 4.56 kg/m 2 , comorbilidades 17.16%, tiempo quirúrgico 54.07 ± 14.10 minutos, días/ estancia 1.96 ± 2.23, sin complicaciones ni defunciones.

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An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery

Cited by 7 publications

References 19 publications

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

¿Influye la obesidad en la morbimortalidad de la colecistectomía laparoscópica?

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