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1.
Tidsskr Nor Laegeforen ; 144(7)2024 Jun 04.
Artículo en Noruego | MEDLINE | ID: mdl-38832622

RESUMEN

Background: Common bile duct stones occur in 2-12 % of all patients who undergo laparoscopic cholecystectomy. Laparoscopic transcystic extraction of bile duct stones as a one-step procedure is an alternative to endoscopic retrograde cholangiopancreatography (ERCP), with comparable success and complication rates. The study aimed to survey the clinical course in patients who underwent transcystic stone extraction and cholecystectomy simultaneously. Material and method: All patients who underwent transcystic stone extraction in conjunction with laparoscopic cholecystectomy at Oslo University Hospital, Ullevål in the period 1 January 2019 to 30 November 2023 were registered. Results: The study included 23 patients, of whom 16 were women and 7 were men. Five patients had previously undergone a Roux-en-Y gastric bypass. A total of 20 patients had undergone surgery with gallstones as the indication. Transcystic stone extraction was successful in 22 patients. The median length of surgery (range) was 190 (115-302) minutes. Three patients developed mild complications related to the procedure. The median number of hospital bed days following the operation was 1 (range: 1-22). Interpretation: Laparoscopic transcystic stone extraction in conjunction with cholecystectomy may be a good alternative treatment for common bile duct stones and appears to be associated with few complications.


Asunto(s)
Colecistectomía Laparoscópica , Cálculos Biliares , Humanos , Masculino , Femenino , Colecistectomía Laparoscópica/métodos , Persona de Mediana Edad , Adulto , Anciano , Cálculos Biliares/cirugía , Tiempo de Internación , Tempo Operativo , Anciano de 80 o más Años , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento
2.
BMC Anesthesiol ; 24(1): 203, 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38851689

RESUMEN

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. METHODS: The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. RESULTS: There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. CONCLUSION: Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.


Asunto(s)
Músculos Abdominales , Colecistectomía Laparoscópica , Bloqueo Nervioso , Dolor Postoperatorio , Ropivacaína , Ultrasonografía Intervencional , Humanos , Colecistectomía Laparoscópica/métodos , Femenino , Masculino , Ultrasonografía Intervencional/métodos , Bloqueo Nervioso/métodos , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Ropivacaína/administración & dosificación , Adulto , Anestésicos Locales/administración & dosificación , Dimensión del Dolor/métodos , Recto del Abdomen/inervación , Recto del Abdomen/diagnóstico por imagen , Satisfacción del Paciente , Analgesia Controlada por el Paciente/métodos , Anciano
3.
S Afr J Surg ; 62(2): 69, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38838125

RESUMEN

BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of care for symptomatic gallstone disease. The procedure has a steep learning curve and may result in significant postoperative morbidity and mortality. LC carries a morbidity of 1.6-5.3%, a mortality of 0.05-0.14% and readmission rates of 3.3% (0-11.7%). We aimed to evaluate the 30-day outcomes of LC across four metropole hospitals in the Western Cape (WC) including mortality, length of stay, readmissions and complications according to the Clavien-Dindo classification system. METHODS: A retrospective review of a prospective database was performed. Data were collected between September 2019 and July 2022. Relative clinical, operative findings and postoperative outcomes were analysed. RESULTS: There were 1 000 consecutive LCs included in this study. The mean postoperative length of stay was 1.92 days. Forty surgical complications were noted of which the most common were a bile leak (n = 14) and intra-abdominal collections (n = 11). Seven patients with bile leaks required reintervention. Four (0.4%) bile duct injuries (BDI) were reported in our series. Twenty-five percent of postoperative complications were graded as Clavien-Dindo IIIa and 28% were graded as Clavien-Dindo IIIb. The 30-day readmission rate was 3.8% (n = 38). Thirty-five patients were readmitted with surgical complications. There were three reported deaths (0.3%). CONCLUSION: Laparoscopic cholecystectomy is considered the standard of treatment for gallstone disease but a small percentage may have serious complications. The outcomes reported in this series are similar to that of other reported studies.


Asunto(s)
Colecistectomía Laparoscópica , Cálculos Biliares , Hospitales Públicos , Tiempo de Internación , Readmisión del Paciente , Complicaciones Posoperatorias , Humanos , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Masculino , Femenino , Sudáfrica , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Adulto , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Cálculos Biliares/cirugía , Anciano , Resultado del Tratamiento , Anciano de 80 o más Años
4.
J Robot Surg ; 18(1): 242, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38837047

RESUMEN

Laparoscopic cholecystectomy (LC) is the established gold standard treatment for benign gallbladder diseases. However, robotic cholecystectomy is still controversial. Therefore, we aimed to compare intraoperative and postoperative outcomes in LC and robotic-assisted cholecystectomy (RAC) in patients with nonmalignant gallbladder conditions. PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for studies comparing RAC to LC in patients with benign gallbladder disease. Only randomized trials and non-randomized studies with propensity score matching were included. Mean differences (MDs) were computed for continuous outcomes and odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.2.3. A total of 13 studies comprising 22,440 patients were included, of whom 10,758 patients (47.94%) underwent RAC. The mean age was 48.5 years and 65.2% were female. Compared with LC, RAC significantly increased operative time (MD 12.59 min; 95% CI 5.62-19.55; p < 0.01; I2 = 79%). However, there were no significant differences between the groups in hospitalization time (MD -0.18 days; 95% CI - 0.43-0.07; p = 0.07; I2 = 89%), occurrence of intraoperative complications (OR 0.66; 95% CI 0.38-1.15; p = 0.14; I2 = 35%) and bile duct injury (OR 0.99; 95% CI 0.64, 1.55; p = 0.97; I2 = 0%). RAC was associated with an increase in operative time compared with LC without increasing hospitalization time or the incidence of intraoperative complications. These findings suggest that RAC is a safe approach to benign gallbladder disease.


Asunto(s)
Colecistectomía Laparoscópica , Enfermedades de la Vesícula Biliar , Tempo Operativo , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Colecistectomía Laparoscópica/métodos , Enfermedades de la Vesícula Biliar/cirugía , Femenino , Resultado del Tratamiento , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Masculino , Persona de Mediana Edad
5.
Khirurgiia (Mosk) ; (5): 14-20, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38785234

RESUMEN

OBJECTIVE: To study the possibilities of minimally invasive methods for removing intra-abdominal calculi after laparoscopic cholecystectomy. MATERIAL AND METHODS: There were 5 patients with abdominal abscesses associated with infected calculi after previous laparoscopic cholecystectomy at the Sklifosovsky Research Institute for Emergency Care between 2020 and 2023. Mean age of patients was 55±12 years. There were 3 (60%) women and 2 (40%) men. All patients underwent minimally invasive treatment. RESULTS: Four patients (80%) underwent percutaneous drainage of abscess with subsequent replacement by larger drains and removal of calculi with endoscopic assistance. Event-free period after cholecystectomy was 44±32 months. One patient developed subhepatic abscess in 72 months after laparoscopic cholecystectomy. This patient underwent transluminal removal of calculus through the duodenal wall. There was 1 calculus in 3 (60%) patients, 2 calculi in 1 (20%) patient and 3 calculi in 1 (20%) patient. CONCLUSION: The above-mentioned cases demonstrate successful minimally invasive interventions for symptomatic abdominal calculi after laparoscopic cholecystectomy. Minimally invasive treatment can reduce surgical aggression and accelerate rehabilitation.


Asunto(s)
Absceso Abdominal , Colecistectomía Laparoscópica , Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Masculino , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Femenino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Drenaje/métodos , Anciano , Adulto , Resultado del Tratamiento , Cálculos Biliares/cirugía
6.
Zhonghua Wai Ke Za Zhi ; 62(4): 265-272, 2024 Apr 01.
Artículo en Chino | MEDLINE | ID: mdl-38582611

RESUMEN

The incidence of gallbladder cancer has been increasing. Radial resection is still the most promising curable treatment for patients with gallbladder cancer. Although the techniques required for laparoscopic radical resection of gallbladder cancer have matured, the number of reports is also on the rise, and laparoscopic radical resection of gallbladder cancer is still controversial. To standardize laparoscopic radical resection of gallbladder cancer, the Biliary Surgery Branch, Chinese Society of Surgery, Chinese Medical Association, together with the Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons, gathered experts to formulate recommendations and consensus on laparoscopic radical resection of gallbladder cancer. This consensus includes several parts: safety, preoperative evaluation, indications, surgical team, positioning of patient and trocars, intraoperative frozen examination, lymph node dissection, liver resection,bile duct resection, etc. Furthermore, suggestions on the principle of treatment, surgical procedures, and precautions were also provided for patients with delayed diagnoses of gallbladder cancer undergoing resection. This consensus aims to offer valuable suggestions for the standardization of laparoscopic radical resection of gallbladder cancer.


Asunto(s)
Colecistectomía Laparoscópica , Neoplasias de la Vesícula Biliar , Laparoscopía , Humanos , Neoplasias de la Vesícula Biliar/diagnóstico , Consenso , Colecistectomía/métodos , Conductos Biliares/patología , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos
7.
Comput Biol Med ; 174: 108470, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38636326

RESUMEN

Deep Learning (DL) has achieved robust competency assessment in various high-stakes fields. However, the applicability of DL models is often hampered by their substantial data requirements and confinement to specific training domains. This prevents them from transitioning to new tasks where data is scarce. Therefore, domain adaptation emerges as a critical element for the practical implementation of DL in real-world scenarios. Herein, we introduce A-VBANet, a novel meta-learning model capable of delivering domain-agnostic skill assessment via one-shot learning. Our methodology has been tested by assessing surgical skills on five laparoscopic and robotic simulators and real-life laparoscopic cholecystectomy. Our model successfully adapted with accuracies up to 99.5 % in one-shot and 99.9 % in few-shot settings for simulated tasks and 89.7 % for laparoscopic cholecystectomy. This study marks the first instance of a domain-agnostic methodology for skill assessment in critical fields setting a precedent for the broad application of DL across diverse real-life domains with limited data.


Asunto(s)
Competencia Clínica , Aprendizaje Profundo , Humanos , Colecistectomía Laparoscópica/métodos , Laparoscopía
8.
Am Surg ; 90(6): 1800-1802, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38565170

RESUMEN

Laparoscopic subtotal cholecystectomy (LSC) is utilized to prevent complications in the difficult cholecystectomy. Medium-term outcomes are poorly studied for fenestrating and reconstituting operative techniques. A single-institution retrospective review was undertaken of all LSCs. A telephone survey was used to identify complications addressed at other institutions. We performed subgroup analyses by operative approach and of patients requiring postoperative endoscopic intervention (ERC). 28 patients met inclusion criteria. The median follow-up was 32.7 months. There were no bile duct injuries or reoperations. 21% of patients required a postoperative ERC and 50% were discharged home with a drain. Bile leaks were found to be more prevalent in the fenestrating LSC group (38% vs 0%, P = .003). The case series suggested more severe recurrent biliary disease in patients undergoing reconstituting LSC. Laparoscopic subtotal cholecystectomy appears to have satisfactory medium-term outcomes. The reconstituting LSC group trends toward more severe recurrent disease which warrants further investigation.


Asunto(s)
Colecistectomía Laparoscópica , Alta del Paciente , Complicaciones Posoperatorias , Humanos , Colecistectomía Laparoscópica/métodos , Colecistectomía Laparoscópica/efectos adversos , Estudios Retrospectivos , Femenino , Masculino , Estudios de Seguimiento , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Adulto , Resultado del Tratamiento , Anciano , Recurrencia , Reoperación/estadística & datos numéricos
9.
J Laparoendosc Adv Surg Tech A ; 34(5): 407-414, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38574306

RESUMEN

Background: Difficult laparoscopic cholecystectomy (LC) has been challenging for surgeons. Randhawa's system used operative time, complications, and conversion to define three difficulty grades. However, using fixed numbers of operative time as dividers among three groups might not be applicable universally. This study aimed to propose new classification with more flexible parameters. Methods: This retrospective cohort study was conducted with patients who underwent LC because of gallstone-related diseases between January 2017 and December 2021 at Thammasat University Hospital. The exclusion criteria were (1) emergent LC for acute cholecystitis, (2) other procedures performed in the same setting of LC, (3) incomplete information, and (4) LC converted to open cholecystectomy. Patients were categorized into three groups using Randhawa's classification. Thereafter, new classification using mean and standard deviation was applied to reclassify patients into three new groups. The comparison between two grading results was performed to prove the advantage of new classification. Results: Total of 523 patients who underwent LC were included with median age 59.3 years old and 60.8% female. By Randhawa classification, proportions of easy, difficult, and very difficult groups were 39%, 53.7%, and 7.3%, respectively. Then, the new operative-time dividers among three groups were changed from 60 and 120 minutes to mean and mean + 2SD, respectively. Reclassified three difficult groups were 38.9%, 57.1%, and 4%. The comparison demonstrated new classification as more flexible and more compatible with each individual surgeon. Conclusions: New surgeon-referenced grading system of difficult LC included surgeon's factors, not only unfavorable operative findings. This classification should be more flexible than the previous criterion-referenced one. Thai Clinical Trials Registry at https://www.thaiclinicaltrials.org with Number TCTR20220426003.


Asunto(s)
Colecistectomía Laparoscópica , Tempo Operativo , Humanos , Colecistectomía Laparoscópica/métodos , Femenino , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Anciano , Adulto , Complicaciones Posoperatorias/clasificación , Cálculos Biliares/cirugía , Cálculos Biliares/clasificación
10.
J Hepatobiliary Pancreat Sci ; 31(5): 305-307, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38558533

RESUMEN

This preliminary study is the first to demonstrate that AI can precisely identify loose connective tissue during laparoscopic cholecystectomy and ICG fluorescent cholangiography. Tashiro and colleagues conclude that this novel real-time navigation modality fusing AI and ICG fluorescent imaging may enhance safety and provide more reliable laparoscopic or robotic surgery.


Asunto(s)
Inteligencia Artificial , Colecistectomía Laparoscópica , Verde de Indocianina , Colecistectomía Laparoscópica/métodos , Humanos , Cirugía Asistida por Computador/métodos , Colangiografía/métodos , Colorantes , Imagen Óptica/métodos
11.
J Gastrointest Surg ; 28(6): 877-879, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38584017

RESUMEN

BACKGROUND: This study aimed to evaluate the use of artificial intelligence (AI) to detect the critical view of safety during elective laparoscopic cholecystectomy. METHODS: This was a prospective, observational study evaluating the detection of the critical view of safety with an AI software in a consecutive series of elective laparoscopic cholecystectomies compared with the blinded evaluation of 3 surgeons. The program was created using the digital tools PyCharm (JetBrains), Google Colab Pro (https://colab.google/), and YOLOv8 (Ultralytics). RESULTS: A total of 40 consecutive elective laparoscopic cholecystectomies were included in the study. The program was able to detect the critical view of safety in all cases following the experts' blinded opinion. CONCLUSION: In this preliminary experience, an AI software was able to detect the critical view of safety in elective laparoscopic cholecystectomies. Its application during nonelective cases, in which the critical view of safety is harder to achieve, might warrant further studies.


Asunto(s)
Inteligencia Artificial , Colecistectomía Laparoscópica , Procedimientos Quirúrgicos Electivos , Seguridad del Paciente , Humanos , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Electivos/efectos adversos , Programas Informáticos , Adulto , Anciano
12.
World J Surg ; 48(6): 1323-1330, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38581358

RESUMEN

BACKGROUND: Laparoscopic subtotal cholecystectomy (LSC) is a safe alternative for difficult cholecystectomies to prevent bile duct injury and open conversion. The primary aim was to detail the use and outcomes on LSCs. METHODS: Retrospective analysis of a prospectively maintained database of laparoscopic cholecystectomy (LC). Relative clinical factors, outcomes, and 30-day follow-up between LSC and LC were compared using univariate and multivariate analyses. RESULTS: Six hundred and twenty four cholecystectomies were performed and 53 (8.5%) required LSC. 81.8% were fenestrating LSC. Male sex was significantly overrepresented in the LSC group (p < 0.01) and patients requiring LSC were significantly older (p < 0.01). Same admission cholecystectomy was associated with a higher risk of LSC (p < 0.01). Patients with a history of previous surgery, preoperative ERCP, or percutaneous cholecystostomy had an increased risk of undergoing LSC (p < 0.01). A necrotic gallbladder was the most significant predictor of the need for a LSC (p < 0.001). A contracted gallbladder, extensive adhesions, gallbladder empyema, and severe inflammation were significant predictors of difficulty (all p < 0.01). Postoperative complications occurred in 26.4% of LSC patients. There were ten (18.9%) Clavien-Dindo Grade III complications, 5.7% required ERCPs, and 9.4% required relook laparotomies. Significantly, more patients in the LSC group developed bile leaks (n = 8, 15%) (p < 0.001). There were two readmissions within 30 days, one mortality, and no BDIs occurred in the LSC cohort. CONCLUSION: LSC provides a feasible surgical option that should be utilized in complex cholecystitis.


Asunto(s)
Colecistectomía Laparoscópica , Humanos , Masculino , Femenino , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Anciano , Países en Desarrollo , Complicaciones Posoperatorias/epidemiología
13.
Khirurgiia (Mosk) ; (4): 105-111, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38634591

RESUMEN

OBJECTIVE: To prove from a clinical and economic point of view the expediency of using ICG cholangiography in patients with «difficult¼ laparoscopic cholecystectomy for the prevention of damage to the bile ducts. MATERIAL AND METHODS: The results of treatment of 173 patients with cholelithiasis at various levels of health care providing were analyzed with regard to assessment of indicators of surgery complexity, developed complications and economic costs. RESULTS: The effectiveness of the original scale of «difficult¼ laparoscopic cholecystectomy has been proved. The financial and economic costs of treatment of patients with damage of biliary ducts and patients with cholelithiasis without development of complications have been analyzed and evaluated. A comparative description of financial costs for patients with «difficult¼ laparoscopic cholecystectomy with the use of ICG-cholangiography has been given. A program on care delivery for patients suffering from cholelithiasis in the conditions of region with regard to safety and economic effectiveness has been developed. CONCLUSION: The implementation of this program provides the minimization of postoperative complications and fatality at all levels of surgical care delivery. It has been established that a rational approach to reducing the number of biliary ducts damages is their prevention by prediction of «difficult¼ laparoscopic cholecystectomy and performance of such interventions in medical organizations of III level with the possibility of modern technologies use.


Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis , Humanos , Colecistectomía Laparoscópica/métodos , Verde de Indocianina , Colangiografía/métodos , Conductos Biliares , Colelitiasis/cirugía
14.
Surg Laparosc Endosc Percutan Tech ; 34(2): 201-205, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38571322

RESUMEN

BACKGROUND: With the aging of the global population, the incidence rate of acute cholecystitis is increasing. Laparoscopic cholecystectomy is considered as the first choice to treat acute cholecystitis. How to effectively avoid serious intraoperative complications such as bile duct and blood vessel injury is still a difficult problem that puzzles surgeons. This paper introduces the application of laparoscopic cholecystectomy, a new surgical concept, in acute difficult cholecystitis. METHODS: This retrospective analysis was carried out from January 2019 to January 2021. A total of 36 patients with acute difficult cholecystitis underwent 3-step laparoscopic cholecystectomy. The general information, clinical features, surgical methods, surgical results, and postoperative complications of the patients were analyzed. RESULTS: All patients successfully completed the surgery, one of them was converted to laparotomy, and the other 35 cases were treated with 3-step laparoscopic cholecystectomy. Postoperative bile leakage occurred in 2 cases (5.56%), secondary choledocholithiasis in 1 case (2.78%), and hepatic effusion in 1 case (2.78%). No postoperative bleeding, septal infection, and other complications occurred, and no postoperative colon injury, gastroduodenal injury, liver injury, bile duct injury, vascular injury, and other surgery-related complications occurred. All 36 patients were discharged from hospital after successful recovery. No one died 30 days after surgery, and there was no abnormality in outpatient follow-up for 3 months after surgery. CONCLUSIONS: Three-step laparoscopic cholecystectomy seems to be safer and more feasible for acute difficult cholecystitis patients. Compared with traditional laparoscopic cholecystectomy or partial cholecystectomy, 3-step laparoscopic cholecystectomy has the advantages of safe surgery and less complications, which is worth trying by clinicians.


Asunto(s)
Colecistectomía Laparoscópica , Colecistitis Aguda , Humanos , Colecistectomía Laparoscópica/métodos , Estudios Retrospectivos , Colecistectomía/métodos , Colecistitis Aguda/cirugía , Colecistitis Aguda/etiología , Conductos Biliares/lesiones
15.
Rev Assoc Med Bras (1992) ; 70(3): e20231457, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38656013

RESUMEN

OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.


Asunto(s)
Colecistectomía Laparoscópica , Bloqueo Nervioso , Dimensión del Dolor , Dolor Postoperatorio , Tramadol , Humanos , Colecistectomía Laparoscópica/métodos , Persona de Mediana Edad , Adulto , Bloqueo Nervioso/métodos , Masculino , Femenino , Dolor Postoperatorio/prevención & control , Anciano , Adulto Joven , Adolescente , Tramadol/administración & dosificación , Analgésicos Opioides/administración & dosificación , Resultado del Tratamiento , Músculos Paraespinales/inervación , Analgesia Controlada por el Paciente/métodos , Factores de Tiempo
16.
Zhonghua Wai Ke Za Zhi ; 62(4): 273-277, 2024 Apr 01.
Artículo en Chino | MEDLINE | ID: mdl-38432667

RESUMEN

Gallbladder cancer, notoriously known for its high malignancy, predominantly requires radical surgery as the treatment of choice. Although laparoscopic techniques have become increasingly prevalent in abdominal surgeries in recent years, the progress of laparoscopic techniques in gallbladder cancer is relatively slow. Due to the anatomical complexity, technical difficulty, and biological features of gallbladder cancer that is prone to metastasis and dissemination, traditional open surgery is still the main surgical approach. This study aims to reappraisal the current state of laparoscopic surgery for gallbladder cancer by appraising clinical practice and research evidence. Laparoscopic surgery for various stages of gallbladder cancer, including early, advanced, incidental, and unresectable gallbladder cancer were discussed. The promise and limitations of laparoscopic techniques are systematically explored.


Asunto(s)
Colecistectomía Laparoscópica , Neoplasias de la Vesícula Biliar , Laparoscopía , Humanos , Neoplasias de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/patología , Colecistectomía Laparoscópica/métodos , Hallazgos Incidentales , Colecistectomía/métodos
17.
Gan To Kagaku Ryoho ; 51(3): 317-319, 2024 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-38494817

RESUMEN

The indocyanine green(ICG)fluorescence navigation that we have standardized for laparoscopic liver resection is useful for partial liver resection and anatomical liver resection for liver cancer, and extended cholecystectomy for gallbladder cancer. In partial liver resection we believe that it is possible to secure a resection margin by not exposing the fluorescence emission around the tumor. In anatomical liver resection, real-time navigation becomes possible by transecting the liver at the boundary between colored and non-colored area, which contributes to precise liver surgery. In extended cholecystectomy, it is difficult to inject ICG from the cystic artery which was performed in open liver resection. So, we encircled Calot's triangle using the Glissonean approach from the ventral side of the gallbladder plate and then taped the hilar Glissonean pedicles. After clamping this tape, ICG was injected into the vein. By using this method, laparoscopic surgery has become possible in the same way as open surgery. With further spread in the future, it is hoped that liver resection using ICG fluorescence navigation will not only be precise, but also safe and highly curative surgery.


Asunto(s)
Colecistectomía Laparoscópica , Laparoscopía , Neoplasias Hepáticas , Humanos , Fluorescencia , Laparoscopía/métodos , Verde de Indocianina , Hepatectomía/métodos , Hígado , Neoplasias Hepáticas/cirugía , Colecistectomía Laparoscópica/métodos
18.
Chirurgia (Bucur) ; 119(1): 44-55, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38465715

RESUMEN

Introduction: Acute cholecystitis (AC) represents a public health problem, increasing hospitalization costs, especially determined by the surgical treatment of these patients. Laparoscopic cholecystectomy (LC) has become the therapeutic gold standard, the timing of the intervention: early (ELC) versus late (DLC), is still debated, impacting the results. The primary objective of the study was to compare postoperative outcomes between ELC and DLC. Secondary objectives assessed surgical outcomes from the pre-pandemic period with those from the Covid-19 pandemic. Material and methods: A retrospective observational study is presented of 266 patients diagnosed with AC who were admitted to Clinic I of General Surgery, County Emergency Clinical Hospital of T #226;rgu Mure #351;, from 2018 to 2022. They were classified into the ELC group ( 72 hours from the onset of symptoms) and DLC ( 72 hours from symptom onset) and were further stratified into prepandemic and pandemic cohorts. Data on clinical symptoms, paraclinical data, surgical details, and postoperative course were collected and analyzed. Discussion: The results confirm fewer conversions to open surgery and reduced hospitalization in the ELC group. The pandemic did not significantly alter the timing of surgeries or patient demographics. Conclusion: In conclusion, ELC for AC patients offers significant advantages, justifying its preference over DLC Despite the decrease in the incidence of AC hospitalizations during the pandemic, postoperative outcomes are comparable to those in the pre-pandemic period. Future multicenter studies are recommended for a broader analysis of the efficacy of laparoscopic surgery in emergency settings.


Asunto(s)
Colecistectomía Laparoscópica , Colecistitis Aguda , Humanos , Colecistectomía Laparoscópica/métodos , Colecistitis Aguda/cirugía , Tiempo de Internación , Pandemias , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
19.
Surg Innov ; 31(3): 286-290, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38444075

RESUMEN

BACKGROUND: Although the technique of single-incision laparoscopic cholecystectomy (SILC) has improved remarkably, problems such as limited exposure and instrument collision persist. We describe a new SILC technique that uses a set of specially-designed needle instruments. METHODS: Fifty-six patients with benign gallbladder disease underwent SILC using the newly-designed needle assembly instruments (NAIs). The NAIs comprise an needle assembly exposing hook for operative field exposure and an needle assembly electrocoagulation hook for dissection. During the operation, the NAIs were assembled and disassembled before and after gallbladder removal within the abdominal cavity. The operative efficacy and postoperative complications of this procedure were evaluated. RESULTS: SILC was completed successfully in 52 cases, and four cases (7.14%) required an additional trocar. There were no conversions to open surgery. The mean operative time was 48.2 ± 21.8 min, and the mean operative bleeding volume was 10.5 ± 12.5 mL. Minor postoperative complications occurred in 3 cases, including 2 cases of localized fluid accumulation in the abdominal cavity and 1 case of pulmonary infection, and all of them recovered after conservative treatment. There was no occurrence of bile leak, abdominal bleeding, bile duct injury and incisional hernia. The medical cost of each case was saved by approximately $200. The abdominal scars produced by the needle instruments were negligible. CONCLUSION: NAIs can make SILC safer, more convenient, and less expensive.


Asunto(s)
Colecistectomía Laparoscópica , Agujas , Humanos , Colecistectomía Laparoscópica/instrumentación , Colecistectomía Laparoscópica/métodos , Femenino , Persona de Mediana Edad , Masculino , Adulto , Anciano , Enfermedades de la Vesícula Biliar/cirugía , Diseño de Equipo , Complicaciones Posoperatorias , Resultado del Tratamiento , Tempo Operativo
20.
J Robot Surg ; 18(1): 118, 2024 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-38478186

RESUMEN

Single-incision laparoscopic cholecystectomy (SILC) has declined in popularity, posing a challenge for novice surgeons. However, robotic single-site cholecystectomy (RSSC) has gained popularity in hepatopancreatic surgery, suggesting a paradigm shift in minimally invasive procedures due to the advantages of robotic platforms. The purpose of this study was to compare the surgical outcomes and learning curves between experts and novices without SILC experience, and discuss the utility and potential of RSSC for novice surgeons. A total of 235 patients underwent RSSC between April 2019 and June 2023 at the OOO University Hospital. Among them, 31 cases from novice and expert surgeons were selected to compare their initial experience. Comprehensive demographic and perioperative factors were analyzed and statistical comparisons were made, including cumulative sum analysis (CUSUM) for learning curves. The demographic factors showed no statistically significant differences between the two groups. Although the docking time (P < 0.001) and hospital stay (P = 0.014) were statistically significant, the total operative time and other perioperative factors were comparable. Novice surgeons demonstrated a shorter absolute total operative time, primarily attributed to differences in docking time. The CUSUM analysis indicated a shorter learning curve for novice surgeons. This study shows that the inherent benefits of the robotic platform make it an accessible and reproducible technique for novices. The benefits of integrating observational learning into robotic surgery training programs and the intrinsic advantages of the robotic platform in minimizing the learning curve for RSSC were also highlighted.


Asunto(s)
Colecistectomía Laparoscópica , Procedimientos Quirúrgicos Robotizados , Robótica , Cirujanos , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Colecistectomía/métodos , Colecistectomía Laparoscópica/métodos , Curva de Aprendizaje , Tempo Operativo , Estudios Retrospectivos
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