Laparoscopic Cholecystectomy: Technical Performance, Safety and Patient's Benefity

Abstract

Laparoscopic cholecystectomy seems to be the most promising new technique for the treatment of symptomatic gallstone disease. For different reasons, controlled clinical trials comparing comfort and trauma for the patient of conventional versus laparoscopic cholecystectomy are difficult to perform at our institution. We therefore report on the results of our first 400 laparoscopic cholecystectomies using a strict and detailed protocol on technical performance, safety and benefit for the patient. Data was obtained immediately after the operation and after a short-term follow-up. To analyze the technical performance and the safety of the procedure, we developed a new classification system (I-V) of adverse events, including both the patients' and the surgeons' viewpoints. Our results show that in nearly 80% of the cases an optimal result (no adverse events in any respect) was obtained. For different reasons, the surgical procedure had to be changed during the operation in 20 cases (5%). In 3 cases (0.8%), an injury of the common bile duct occurred; 2 patients died (mortality 0.5%). On the first post-operative day, vomiting occurred in only 8% and nausea in 19% of the patients. Pain intensity was always below the level where patients demand analgesic medication and declined near zero the day after the operation. Patients fatigue was measured on a scale from 0-10 and rose from 2.2 preoperatively to 3.3 postoperatively. Only a short hospital stay of 3 days median was required. At short-term follow-up 6 weeks after the operation, pain was only rarely reported, the patients were fit and only 20% avoided some kind of food. We conclude that laparoscopic cholecystectomy is the treatment of choice for this precisely defined patient population with symptomatic gallstone disease.

Costs of laparoscopic cholecystectomy

“…Out of a subgroup of 234 consecutive patients selected for follow-up 176 (75.2%) were seen after 2 weeks, and 177 (75.6%) after 6 weeks, and data on the duration of inability to work, additional complications, and medical treatments were collected. The details of the operative technique have been previously described [24,25], and reusable instruments were used. The duration of operation decreased during the study period and the mean duration of the most recent 234 operations was used for calculation.…”

“…A Correspondence to: B. M. Ure potential prevention of all wound infections that had occurred in the present series (n = 10) by disposable instruments would have cost an additional 541,844 DM or 54,184 DM per infection prevented. In conclusion, disposable instruments are not cost-effective.The results of this study may contribute to further significant cost savings of laparoscopic cholecystectomy.Laparoscopic cholecystectomy offers significant advantages over the conventional procedure [2,15,17,18,24,25,27] and it has developed rapidly as a safe and effective technique. Economic aspects of laparoscopic compared to conventional cholecystectomy have been investigated [4,5,13,15], but the specific components of the total costs remain unclear.…”

“…Laparoscopic cholecystectomy offers significant advantages over the conventional procedure [2,15,17,18,24,25,27] and it has developed rapidly as a safe and effective technique. Economic aspects of laparoscopic compared to conventional cholecystectomy have been investigated [4,5,13,15], but the specific components of the total costs remain unclear.…”

Segmentation of Arteries in Minimally Invasive Surgery Using Change Detection

“…However, current methods are complicated, time consuming, and require expensive and highly technical medical equipment and expertise. As such, they are not suitable for ordinary laparoscopic surgery [21], [22]. In this study, we have evaluated a method for artery detection that does not call for any extra equipment.…”

A Comparison Between Intravenous Paracetamol Plus Intravenous Fentanyl and Intravenous Fentanyl Plus Intravenous Ketorolac for Postoperative Analgesia During Laparoscopic Cholecystectomy

“…1 Pain is the most common complaint after laparoscopic cholecystectomy 2,3 resulting in the use of rescue opioid analgesics in up to 80% patients. 4 Furthermore, the pattern of pain after laparoscopic cholecystectomy is complex and unlikely to benefit always from identical analgesic treatment.…”