A new minimally invasive technique for cholecystectomy. Subxiphoid "minimal stress triangle": microceliotomy.

OBJECTIVE: The authors devised a minimally invasive technique for cholecystectomy via microceliotomy that provides safety attainable with the open conventional approach and postoperative results comparable to laparoscopic cholecystectomy. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy has evolved as a minimally invasive outpatient procedure. Patients can return rapidly to preoperative status with minimal postoperative morbidity and pain, and the small scar size is cosmetically desirable. Unfortunately, there are reports of serious intraoperative complications, including injury to blood vessels, bowel, and the bile ducts, caused by failure to identify structures properly. The conventional cholecystectomy technique currently is relegated to patients on whom the laparoscopic procedure cannot be performed. METHODS: Cholecystectomy was performed through a 3-cm transverse high subxiphoid incision in the "minimal stress triangle." The location, anterior to Calot's triangle, was critical in providing a direct vertical view of the biliary ducts during dissection. Direct view cholecystectomy was performed using endoscopic instruments without pneumoperitoneum. Postoperative data were compared with both laparoscopic and open cholecystectomy results. RESULTS: Using the microceliotomy technique in the ambulatory setting, cholecystectomy was performed successfully in 99.3% (N = 143) of cases. Biliary leakage beyond the third postoperative day was caused by failure of clips or obstruction to bile flow. The postoperative morbidity, acceptability of scar, and analgesic requirements compare favorably with other techniques. Microceliotomy is cost effective. Portal hypertension is a contraindication for this procedure. CONCLUSIONS: The microceliotomy approach offers a viable, safe, and cost-effective alternative to the laparoscopic technique for cholecystectomy, especially when facilities for laparoscopy are not available or when the laparoscopic procedure cannot be performed.

Studies on characterization of mosquito cell lines.

Results of studies on characterization of mosquito cell lines are described; these include chromosome analysis, image cytometric, and flow cytometric estimation of DNA, tumorogenicity and angiogenicity, concanavalin-A-induced agglutination, and proton spin-lattice relaxation time (T1). The established mosquito cell lines are not diploid lines, although their stem-lines are diploid. Feulgen cytometry and flow cytometry reveal the inherent heterogeneity in DNA contents and support the observations on chromosome frequency distribution. Two cell lines exhibit angiogenic property and cell infiltration in chorio-allantoic membrane of chick embryos; however, none of the cell lines tested by inoculating hamsters, mice, or adult mosquitoes exhibit tumorogenicity. The agglutinability patterns of these cells in response to concanavalin-A treatment reveal the coexistence of agglutinable and unagglutinable cells. The mosquito cells differ from mammalian and chick cells in respect of their proton spin-lattice relaxation time.