Aims/objectives: To devise a 10-point strategy for performing safe laparoscopic cholecystectomy (LC), share experience of 8,000 patients without any conversion to open procedure by adopting the strategy, and assess its effectiveness.
Materials and methods: A total of 8,000 patients were prospectively analyzed during 2007 to 2017. A point was assigned to a specific finding intraoperatively. Patients were divided into three groups based on the points. Anatomical variations, time of surgery, intraoperative/postoperative complications were plotted for three groups, and statistical significance was calculated.
Results: In this study, 63.5% of patients were female. No case of conversion to open cholecystectomy (OC) was found. The youngest and oldest patients were 2 and 109 years old, respectively. Mortality, negligible morbidity, or significant complications were not observed. Group I (1–4 points) had high-risk patients, and lowest safety, and group III (8–10 points) had low-risk patients, and highest safety, and group II (5–7 points) had with equivocal numbers.
Conclusion: Laparoscopic cholecystectomy was performed keeping these 10 points in mind with patience and precautions. Chances of conversion to open surgery can be reduced to zero, with minimal complications. The study suggests that in case of difficult anatomy, go gentle and slow to safeguard from injuries.
Shea JA, Berlin JA, Bachwich DR, et al. Indications for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg 1998;227(3):343. DOI: 10.1097/00000658-199803000-00005.
Gadacz TR. US experience with laparoscopic cholecystectomy. Am J Surg 1993;165(4):450–454. DOI: 10.1016/s0002-9610(05)80939-0.
Champault G, Cazacu F, Taffinder N. Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc 1996;6(5):367–370. DOI: 10.1097/00019509-199610000-00006.
Javaid A, Bashir T, Ali M. Laparoscopic cholecystectomy; conversion rate, experience of a aingle surgeon over 4-year period. J Surg Surgical Res 2017;3(2):030–033. DOI: 10.17352/2455-2968.000041.
National Institutes of Health. National institutes of health consensus development conference statement on gallstones and laparoscopic cholecystectomy. Am J Surg 1993;165(4):390–398. DOI: 10.1016/s0002-9610(05)80929-8.
Walker Reynolds J. The first laparoscopic cholecystectomy. JSLS 2001;5(1):89–94.
Bhattacharjee PK, Halder SK, Rai H, et al. Laparoscopic cholecystectomy: a single surgeon's experience in some of the teaching hospitals of West Bengal. Indian J Surg 2015;77(2):618–623. DOI: 10.1007/s12262-013-0945-x.
Vollmer CM, Callery MP. Biliary injury following laparoscopic cholecystectomy: why still a problem? Gastroenterol 2007;133(3): 1039–1041. DOI: 10.1053/j.gastro.2007.07.041.
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004;188(3): 205–211. DOI: 10.1016/j.amjsurg.2004.06.013.
Demiral G, Aksoy F. Single surgeon experience: intraoperative complications and conversion to open surgery in laparoscopic cholecystectomy, the fore and aft of 20 years’ experience. Biomed Res 2017;28(15):6671–6676.
El Nakeeb A, Mahdy Y, Salem A, et al. Open cholecystectomy has a place in the laparoscopic era: a retrospective cohort study. Indian J Surg 2017;79(5):437–443. DOI: 10.1007/s12262-017-1622-2.
Khan MH, Howard TJ, Fogel EL, et al. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc 2007;65(2):247–252. DOI: 10.1016/j.gie.2005.12.037.
Visser BC, Parks RW, Garden OJ. Open cholecystectomy in the laparoendoscopic era. Am J Surg 2008;195(1):108–114. DOI: 10.1016/j.amjsurg.2007.04.008.
Ashfaq A, Ahmadieh K, Shah AA, et al. The difficult gall bladder: Outcomes following laparoscopic cholecystectomy and the need for open conversion. Am J Surg 2016;212(6):1261–1264. DOI: 10.1016/j.amjsurg.2016.09.024.
Yang TF, Guo L, Wang Q. Evaluation of preoperative risk factor for converting laparoscopic to open cholecystectomy: a meta-analysis. Hepatogastroenterol 2014;61(132):958–965.
Litwin DE, Cahan MA. Laparoscopic cholecystectomy. Surg Clin Nor Am 2008;88(6):1295–1313. DOI: 10.1016/j.suc.2008.07.005.
Azevedo JL, Azevedo OC, Miyahira SA, et al. Injuries caused by veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc 2009;23(7):1428–1432. DOI: 10.1007/s00464-009-0383-9.
Adamsen S, Hansen OH, Funch-Jensen P, et al. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 1997;184(6):571–578.
Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003;237(4):460. DOI: 10.1097/01.SLA.0000060680.92690.E9.
Cuschieri A, Dubois F, Mouiel J, et al. The european experience with laparoscopic cholecystectomy. Am J Surg 1991;161(3):385–387. DOI: 10.1016/0002-9610(91)90603-b.
Jatzko GR, Lisborg PH, Pertl AM, et al. Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy. Ann Surg 1995;221(4):381. DOI: 10.1097/00000658-199504000-00008.
Woods MS, Shellito JL, Santoscoy GS, et al. Cystic duct leaks in laparoscopic cholecystectomy. Am J Surg 1994;168(6):560–565. DOI: 10.1016/s0002-9610(05)80122-9.
Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165(1):9–14. DOI: 10.1016/s0002-9610(05)80397-6.
Huang SM, Wu CW, Hong HT, et al. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 1993;80(12):1590–1592. DOI: 10.1002/bjs.1800801232.
Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo guidelines 2018: surgical management of acute cholecystitis: aafe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepato-Biliary-Pancrea Sci 2018;25(1):73–86. DOI: 10.1002/jhbp.517.
Deal SB, Stefanidis D, Brunt LM, et al. Development of a multimedia tutorial to educate how to assess the critical view of safety in laparoscopic cholecystectomy using expert review and crowd-sourcing. Am J Surg 2017;213(5):988–990. DOI: 10.1016/j.amjsurg.2017.03.023.
Talebpour M, Panahi M. New aspects in laparoscopic cholecystectomy. J Laparoendos Adv Surg Techniq 2007;17(3):290–295. DOI: 10.1089/lap.2006.0090.
Hori T, Oike F, Furuyama H, et al. Protocol for laparoscopic cholecystectomy: Is it rocket science? World J Gastroenterol 2016;22(47):10287. DOI: 10.3748/wjg.v22.i47.10287.
Lockhart S, Singh-Ranger G. Rouviere's sulcus—aspects of incorporating this valuable sign for laparoscopic cholecystectomy. Asian J Surg 2018;41(1):1–3. DOI: 10.1016/j.asjsur.2016.07.012.
Hirajima S, Koh T, Sakai T, et al. Utility of laparoscopic subtotal cholecystectomy with or without cystic duct ligation for severe cholecystitis. Am Surg 2017;83(11):1209–1213. DOI: 10.1177/000313481708301121.
Pucher PH, Brunt LM, Davies N, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc 2018(5):1–9. DOI: 10.1308/rcsann.2017.0229.
Bailey RW, Zucker KA, Flowers JL, et al. Laparoscopic cholecystectomy. Experience with 375 consecutive patients. Ann Surg 1991;214(4):531. DOI: 10.1097/00000658-199110000-00017.
Fabre JM, Fagot H, Domergue J, et al. Laparoscopic cholecystectomy in complicated cholelithiasis. Surg Endosc 1994;8(10):1198–1201. DOI: 10.1007/BF00591050.
Sormaz İC, Soytaş Y, Gök AF, et al. Fundus-first technique and partial cholecystectomy for difficult laparoscopic cholecystectomies. Ulus Travma Acil Cerrahi Derg 2018;24(1):66–70. DOI: 10.5505/tjtes.2017.26795.
Santos BF, Brunt LM, Pucci MJ. The difficult gallbladder: a safe approach to a dangerous problem. J Laparoendos Adv Surg Techniq 2017;27(6):571–578. DOI: 10.1089/lap.2017.0038.