Difficult Situations in Laparoscopic Cholecystectomy

Kala, Sanjay; Verma, Sushil Kumar; Dutta, Gautam

doi:10.1097/sle.0b013e31829cebd8

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…We compared our model to evidence culled from the literature with respect to common errors in VLC [ 16 , 20 , 23 - 29 ] and the difficulty inherent to each step ( Tables 3 , 4 , 5 ). The instructor responsible for resident training supervises trainees through each step until it has been learned; all without distinction as to the type of patients.…”

Section: Resultsmentioning

confidence: 99%

The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

et al. 2016

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AbstractA well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient.Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy.Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress.Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.

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Section: Resultsmentioning

confidence: 99%

The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

et al. 2016

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“…Once reconstituted, the ICG solution was injected via the intravenous route using a dosage of 0.35 mg/Kg. The median timing of administration was 15.6 h prior to surgery (range [8][9][10][11][12][13][14][15][16][17][18][19][20]. Following the administration, patients were monitored for any signs of allergic reaction to the dye.…”

Section: Operative Techniquementioning

confidence: 99%

“…LC seems to be associated with a higher incidence of BDI than previous reports of open cholecystectomy, usually resulting from poor visualization/misinterpretation of anatomic structures [ 6 – 8 ]. Possible explanations include variant anatomy of the biliary tract, obesity, recurrent cholecystitis/cholangitis with resultant adhesions to surrounding structures, fibrosis and distorted anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, or the limited surgical experience [ 7 , 9 , 10 ]. Literature, however, continues to indicate the primary cause of BDI is an error in visual perception of the anatomy in 71–97% of cases [ 11 ].…”

mentioning

confidence: 99%

Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers

et al. 2021

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Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation.

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“…In the past three decades since the introduction of laparoscopic cholecystectomy (LC) in 1985, the management, approach and guidelines of biliary tract surgery have evolved allowing more patients in which relative contraindications existed, to undergo LC in order to benefit from this minimally invasive approach . With the advances in technology, new minimally invasive approaches were developed including single incision laparoscopic cholecystectomy (SILC) and NOTES; however, these techniques have been reported to be cumbersome when “difficult cases” have to be performed . Moreover, many people remain skeptical regarding the role of robotic surgery and the relatively recent emergence of Single Incision Robotic Cholecystectomy (SIRC).…”

Section: Introductionmentioning

confidence: 99%

“…As technology advanced and laparoscopic surgery became more popular newer approaches were developed such as single incision laparoscopic cholecystectomy (SILC) showing acceptable outcomes but reserved for very limited clinical scenarios leaving “difficult cases” for the conventional laparoscopic or open approach. Of note, exclusion criteria for SILC are as follows: (i) patients with acute cholecystitis, (ii) obesity, (iii) previous abdominal surgery, (iv) suspected bile duct stones and/or intrahepatic bile duct stones, (v) suspected malignancy and (vi) ASA of IV and V .…”

Section: Introductionmentioning

confidence: 99%

Description of robotic single site cholecystectomy and a review of outcomes

Dominguez

Hernandez-Murcia

Gonzalez

2015

Journal of Surgical Oncology

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New technologies have been developed to make laparoscopic cholecystectomy less invasive through single incision laparoscopic surgery (SILS), however this approach has its own limitations. Single incision robotic surgery (SIRC) is designed to overcome them. The concerns that limit adoption of this technology are attributed increases in costs, prolonged learning curves and surgical times. Here, we provide a literature review as well as our own experience with SIRC, with the intent to clarify these important concerns.

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Difficult Situations in Laparoscopic Cholecystectomy

Cited by 14 publications

References 24 publications

The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers

Description of robotic single site cholecystectomy and a review of outcomes

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