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Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Standard
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017
AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.
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A laparoscope is a small, thin tube that is put into your body through a tiny cut made just below your navel. Your surgeon can then see your gallbladder on a television screen and do the surgery with tools inserted in three other small cuts made in the right upper part of your abdomen. Your gallbladder is then taken out through one of the incisions.
Purpose The complication rate in patients treated with the Linton procedure was unacceptably high. SEPS is minimal invasive treatment modality for chronic venous insufficiency and venous ulcers. Materials and Methods252 limbs of 229 patients who underwent SEPS procedure and/or safenous vein ablati...on from May 2003 to January 2008. Tourniquet was not used and two-port technique was preferred for operation. Skin graft was not used. Honeysoft (medical honey) was used for wound care in selected cases. Results According to CEAP clinical Classification 112 limbs were class 6, 70 limbs (class 5), 70 limbs (Class4) respectively. Greater saphenous vein stripping and/or high ligation, and varicose vein excision accompanied SEPS in 241limbs who had combined Sapheno-femoral junction and perforator vein insufficiencyand SEPS was performed alone 23 limbs who had recanalised deep venous thrombosis (19) and PVI alone(4). Mean patient follow-up was 35 months. No early deaths or thromboembolism occurred. Complications included severe subcutaneous emphysema(1), neuralgia (7), 1 year later cellulites (1). Ulcers healed in 124 limbs in two months and 58 limbs in 3 months. ulcer recurrence was seen on 12(%6.6) limbs. Clinical severity and disability scores improved significantly after surgery. Conclusion All venous ulcers healed with SEPS combined or not ablation of superficial venous reflux and remain healed 5 year period and symptom-free except recurrent ulcers during the long-term follow-up. SEPS is an effective and safety treatment modality.