SAFETY EVALUATION OF MINILAPAROSCOPIC CHOLECYSTECTOMY
EAES Academy. Mendel M. 07/05/22; 363038; P082
Mykola Mendel
Contributions
Contributions
Abstract
Aims:
The aim of the study was to evaluate safety of minilaparoscopic cholecystectomy (MLC) on the basis of critical view of safety (CVS) achievement.
Methods:
The analysis of 45 video recordings of sequential operations MLC performed in 2015-2020 was carried out. The operations were performed using instruments 3 mm in diameter. The analysis was carried out independently by two co-authors; if the assessments did not coincide, a joint revision of the records was carried out. Indications for the operations were symptomatic cholelithiasis – 41 patient, choledocholithiasis (after ERCP) - 1 patient, and gallbladder polyps larger then 10 mm – 3 patients. All patients were operated on by one surgeon. There were evaluated achievement of CVS (anterior and posterior view) by D. Sanford (2014), presence of anatomical variations and difficulty of laparoscopic cholecystectomy grade by A. Nassar (2015).
Results:
There were 45 patients - 44 females and 1 male who requested MLC due to cosmetic reason. Mean age was 38,5 years (from 23 to 54), body mass index was from 19 to 29 kg/sq.m. Operation length was 59,4 minutes (from 35 to 90). Difficulty of laparoscopic cholecystectomy grade by Nassar was: 1 grade – 39 patients and 2 grade – 6 patients. Typical anatomy was noted in 31 patients, and anatomical variations were noted in 14 (31,1%) patients (multiple small arteries without a clear arterial trunk – 4, two cystic arteries - 4, Caterpillar (Moynihan’s) hump of right hepatic artery - 3, anterior cystic artery – 2, cystic artery from gastroduodenal artery – 1). CVS was completely achieved in 41 (91,1%) cases, doesn’t achieved in 4 cases (8,9%) due to the need to transect the cystic artery, which interfered with complete dissection. CVS was then reached before clipping or ligating cystic duct (we defined this type of CVS as “revised”). Anterior CVS according to Sanford achieved in 41 patients (mean score – 5,5 of 6 maximal), posterior CVS achieved in 38 (mean score - 5,2). The unreached posterior CVS is explained by the fact that at the beginning of the work we did not pay attention to the posterior view when reaching the anterior view. The average score of the foto doublet was 10,7. The average hospital stay was 1,2 days. There were no complications.
Conclusion(s).
In MLC the CVS was achieved in 91,1% of cases, in 8,9% of cases CVS was not achieved formally due to transection of the cystic artery before the end of the dissection. MLC does not differ in safety from traditional laparoscopic cholecystectomy for elective surgery of gallstone disease and has good cosmetic results.
The aim of the study was to evaluate safety of minilaparoscopic cholecystectomy (MLC) on the basis of critical view of safety (CVS) achievement.
Methods:
The analysis of 45 video recordings of sequential operations MLC performed in 2015-2020 was carried out. The operations were performed using instruments 3 mm in diameter. The analysis was carried out independently by two co-authors; if the assessments did not coincide, a joint revision of the records was carried out. Indications for the operations were symptomatic cholelithiasis – 41 patient, choledocholithiasis (after ERCP) - 1 patient, and gallbladder polyps larger then 10 mm – 3 patients. All patients were operated on by one surgeon. There were evaluated achievement of CVS (anterior and posterior view) by D. Sanford (2014), presence of anatomical variations and difficulty of laparoscopic cholecystectomy grade by A. Nassar (2015).
Results:
There were 45 patients - 44 females and 1 male who requested MLC due to cosmetic reason. Mean age was 38,5 years (from 23 to 54), body mass index was from 19 to 29 kg/sq.m. Operation length was 59,4 minutes (from 35 to 90). Difficulty of laparoscopic cholecystectomy grade by Nassar was: 1 grade – 39 patients and 2 grade – 6 patients. Typical anatomy was noted in 31 patients, and anatomical variations were noted in 14 (31,1%) patients (multiple small arteries without a clear arterial trunk – 4, two cystic arteries - 4, Caterpillar (Moynihan’s) hump of right hepatic artery - 3, anterior cystic artery – 2, cystic artery from gastroduodenal artery – 1). CVS was completely achieved in 41 (91,1%) cases, doesn’t achieved in 4 cases (8,9%) due to the need to transect the cystic artery, which interfered with complete dissection. CVS was then reached before clipping or ligating cystic duct (we defined this type of CVS as “revised”). Anterior CVS according to Sanford achieved in 41 patients (mean score – 5,5 of 6 maximal), posterior CVS achieved in 38 (mean score - 5,2). The unreached posterior CVS is explained by the fact that at the beginning of the work we did not pay attention to the posterior view when reaching the anterior view. The average score of the foto doublet was 10,7. The average hospital stay was 1,2 days. There were no complications.
Conclusion(s).
In MLC the CVS was achieved in 91,1% of cases, in 8,9% of cases CVS was not achieved formally due to transection of the cystic artery before the end of the dissection. MLC does not differ in safety from traditional laparoscopic cholecystectomy for elective surgery of gallstone disease and has good cosmetic results.
Aims:
The aim of the study was to evaluate safety of minilaparoscopic cholecystectomy (MLC) on the basis of critical view of safety (CVS) achievement.
Methods:
The analysis of 45 video recordings of sequential operations MLC performed in 2015-2020 was carried out. The operations were performed using instruments 3 mm in diameter. The analysis was carried out independently by two co-authors; if the assessments did not coincide, a joint revision of the records was carried out. Indications for the operations were symptomatic cholelithiasis – 41 patient, choledocholithiasis (after ERCP) - 1 patient, and gallbladder polyps larger then 10 mm – 3 patients. All patients were operated on by one surgeon. There were evaluated achievement of CVS (anterior and posterior view) by D. Sanford (2014), presence of anatomical variations and difficulty of laparoscopic cholecystectomy grade by A. Nassar (2015).
Results:
There were 45 patients - 44 females and 1 male who requested MLC due to cosmetic reason. Mean age was 38,5 years (from 23 to 54), body mass index was from 19 to 29 kg/sq.m. Operation length was 59,4 minutes (from 35 to 90). Difficulty of laparoscopic cholecystectomy grade by Nassar was: 1 grade – 39 patients and 2 grade – 6 patients. Typical anatomy was noted in 31 patients, and anatomical variations were noted in 14 (31,1%) patients (multiple small arteries without a clear arterial trunk – 4, two cystic arteries - 4, Caterpillar (Moynihan’s) hump of right hepatic artery - 3, anterior cystic artery – 2, cystic artery from gastroduodenal artery – 1). CVS was completely achieved in 41 (91,1%) cases, doesn’t achieved in 4 cases (8,9%) due to the need to transect the cystic artery, which interfered with complete dissection. CVS was then reached before clipping or ligating cystic duct (we defined this type of CVS as “revised”). Anterior CVS according to Sanford achieved in 41 patients (mean score – 5,5 of 6 maximal), posterior CVS achieved in 38 (mean score - 5,2). The unreached posterior CVS is explained by the fact that at the beginning of the work we did not pay attention to the posterior view when reaching the anterior view. The average score of the foto doublet was 10,7. The average hospital stay was 1,2 days. There were no complications.
Conclusion(s).
In MLC the CVS was achieved in 91,1% of cases, in 8,9% of cases CVS was not achieved formally due to transection of the cystic artery before the end of the dissection. MLC does not differ in safety from traditional laparoscopic cholecystectomy for elective surgery of gallstone disease and has good cosmetic results.
The aim of the study was to evaluate safety of minilaparoscopic cholecystectomy (MLC) on the basis of critical view of safety (CVS) achievement.
Methods:
The analysis of 45 video recordings of sequential operations MLC performed in 2015-2020 was carried out. The operations were performed using instruments 3 mm in diameter. The analysis was carried out independently by two co-authors; if the assessments did not coincide, a joint revision of the records was carried out. Indications for the operations were symptomatic cholelithiasis – 41 patient, choledocholithiasis (after ERCP) - 1 patient, and gallbladder polyps larger then 10 mm – 3 patients. All patients were operated on by one surgeon. There were evaluated achievement of CVS (anterior and posterior view) by D. Sanford (2014), presence of anatomical variations and difficulty of laparoscopic cholecystectomy grade by A. Nassar (2015).
Results:
There were 45 patients - 44 females and 1 male who requested MLC due to cosmetic reason. Mean age was 38,5 years (from 23 to 54), body mass index was from 19 to 29 kg/sq.m. Operation length was 59,4 minutes (from 35 to 90). Difficulty of laparoscopic cholecystectomy grade by Nassar was: 1 grade – 39 patients and 2 grade – 6 patients. Typical anatomy was noted in 31 patients, and anatomical variations were noted in 14 (31,1%) patients (multiple small arteries without a clear arterial trunk – 4, two cystic arteries - 4, Caterpillar (Moynihan’s) hump of right hepatic artery - 3, anterior cystic artery – 2, cystic artery from gastroduodenal artery – 1). CVS was completely achieved in 41 (91,1%) cases, doesn’t achieved in 4 cases (8,9%) due to the need to transect the cystic artery, which interfered with complete dissection. CVS was then reached before clipping or ligating cystic duct (we defined this type of CVS as “revised”). Anterior CVS according to Sanford achieved in 41 patients (mean score – 5,5 of 6 maximal), posterior CVS achieved in 38 (mean score - 5,2). The unreached posterior CVS is explained by the fact that at the beginning of the work we did not pay attention to the posterior view when reaching the anterior view. The average score of the foto doublet was 10,7. The average hospital stay was 1,2 days. There were no complications.
Conclusion(s).
In MLC the CVS was achieved in 91,1% of cases, in 8,9% of cases CVS was not achieved formally due to transection of the cystic artery before the end of the dissection. MLC does not differ in safety from traditional laparoscopic cholecystectomy for elective surgery of gallstone disease and has good cosmetic results.
{{ help_message }}
{{filter}}