Skip to main content
SpringerLink
Log in

An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The performance of laparoscopic cholecystectomy could be a technical challenge. Procedure success depends on multiple factors namely: hepatobiliary anatomical variations, pathologic changes in the gallbladder and surrounding tissues, pre-operative interventional attempts, the individual surgeon’s skill and finally patient co-morbidities. Anticipating the attendant challenges, can help to avoid several known complications associated with this procedure. Searching a more reliable anatomical topography to adopt during laparoscopic cholecystectomy is the basis for a safe surgical technique.

Methods

Between January 2012 and August 2015, 525 cases were presented with acute cholecystitis. Patients were classified in to two groups regarding degree of dissection difficulty. The study concept is defined and applied by the author in all study cases. No single case was excluded from the study.

Results

Results are processed in comparative way between both groups of the study. The increased risk results in Group B are related to technical difficulties.

Conclusion

The study has offered a novel anatomical concept and safe surgical technique avoiding exploration of Calot’s triangle. The new concept has minimized dissection demands and risk of injury related to the traditional laparoscopic cholecystectomy. The study has proposed a potentially secure and empirical laparoscopic cholecystectomy technique that could be considered in every case.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Specht MJ. Calot’s triangle (letter). JAMA 1967; 200:1186.

    Article  Google Scholar 

  2. Adams DB, Borowicz MR, Wotton FT III, Cunningham JT. Bile duct complications after laparoscopic cholecystectomy. Surg Endosc. 1993; 7:79–83.

    Article  CAS  PubMed  Google Scholar 

  3. Desiel DJ, Millikan KW, Airan MC, Economou SG, Doolas A, Ko ST Complications of laparoscopic cholecystectomy: results of a national survey of 4,292 hospitals and analysis of 77,604 cases. Am J Surg. 1993; 165:9–14.

    Article  Google Scholar 

  4. Moossa AR, Easter DW, Van Sonnenberg E, Casola G, D’Agostino H. Laparoscopic injuries of the bile duct: A cause of concern. Ann Surg. 1992; 215: 203–205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Buddingh KT, Morks AN, ten Cate Hoedemaker HO, Blaauw CB, van Dam G M, Ploeg RJ, Hofker HS, Nieuwenhuijs VB. Documenting correct assessment of biliary anatomy during laparoscopic cholecystectomy, Surg Endosc. 2012; 26:79–85.

    CAS  PubMed  Google Scholar 

  6. Hollinshead WH. Anatomy for surgeons. vol 2: Thorax, Abdomen and Pelvis. New York Harpor & Row, pp 314–374, 1971.

  7. Gadzijev EM. Surgical anatomy of the heptoduodenal ligament and hepatic hilus. J Hepatobiliary Pancreat Surg 2002; 9(5): 531–3.

    Article  PubMed  Google Scholar 

  8. Philip Rothman J, Burcharth J, pommergaard HC, Viereck S, Rosenberg J. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies. Dig Surg:33(5): 414–423. doi:10.1159/000445505.

  9. Yajima H, Kanai H, Son K, Yoshida K, Yanaga K. Reasons and risk factors for intraoperative conversion from laparoscopic to open cholecystectomy. Surg Today. 2014; 44:80–83.

    Article  PubMed  Google Scholar 

  10. Rajkomar K, Bowman M, Rodgers M, Koea JB. Quadrate lobe: a reliable landmark for bile duct anatomy during laparoscopic cholecystectomy. Anz J Surg Apr 8 2016, 2016. doi. 10.1111/ans.13509.

  11. Talamini MA, Gadacz TR. Laparoscopic approach cholecystectomy. Adv Surg. 1992; 25: 1–18.

    CAS  PubMed  Google Scholar 

  12. Zucker KA, Bailey AB, Gadacz TR, Imbembo AL. Laparoscopic guided cholecystectomy. Am J Surg. 1991; 161:36–44.

    Article  CAS  PubMed  Google Scholar 

  13. Way LW. Bile duct injury during laparoscopic cholecystectomy (editorial) Ann Surg. 1992; 215: 195.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME, Newman GE, Cotton PB, Meyers WC. Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg. 1992; 215:196–202.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hunter JG. Avoidance of bile duct injury during laparoscopic cholecystectomy. Am J Surg. 1991; 161:71–76.

    Article  Google Scholar 

  16. Andell RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of the cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. Dec 23, 2016.

  17. Rashid A, Mushtaque M, Bali RS, Nazir S, Khuroo S, Ishaq S. Artery to cystic duct: a consistent branch of cystic artery seen in laparoscopic cholecystectomy. Anat Res Int. doi:10.1155/2015/847812.

  18. Donkervoot SC, Kortram K, Gijksman LM, Boermeester MA, van Ramshorst B, Boerma D. Anticipation of complications after laparoscopic cholecystectomy: prediction of individual outcome. Surg Endosc. Apr 29, 2016.

  19. Stefanidis D, Chintalapudi N, Anderson-Montoya B, Oommen B, Tobben D, Pimentel M. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc. May 3, 2016.

  20. Huang SM, Hsiao KM, Pan H, Yao CC, Lai TJ, Chen LY, Wu CW. Lui WY. Overcoming the difficulties in laparoscopic management of contracted gallbladders with gall stones: possible role of fundus-down approach. Surg Endosc. 2011 Jan. 25(1): 284–91. doi:10.1007/s00464-010-1175-y.

  21. Kelly MD. Laparoscopic retrograde (fundus first) cholecystectomy. BMC Surg. 2009; 9:19. doi:10.1186/1471-2482-9-19.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gupta A, Agarwal PN, Kant R, Malik V. Evaluation of fundus-first laparoscopic cholecystectomy. JSLS. 2004 Jul-sep: 8(3): 255–8.

Download references

Acknowledgments

Authorship

Dr. MMN, the author, has achieved alone the work to take public responsibility for the whole content.

The author; Dr. MMN has independently achieved the followings:- Substantial contributions to the conception and design of the work, the acquisition, analysis, and interpretation of data for the work; AND - Drafting the work and revising it critically for important intellectual content; AND - Final approval of the version to be published; AND - Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Author information

Authors and Affiliations

  1. Endoscopic Surgery Unit, Department of General Surgery, King Fahad Hospital, Huffof, Al Ahsa, Kingdom of Saudi Arabia

    Mohamed Mahmood Nasr

Authors
  1. Mohamed Mahmood Nasr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed Mahmood Nasr.

Ethics declarations

Disclosures

Dr. MMN, the author confirms receiving no funds to support any aspect of this research.

Additional information

Research has been presented in the 17th European Congress of Trauma & Emergency Surgery, April, 24–26, 2016, Vienna, Austria

Research abstract has been published in The European Journal of Trauma and Emergency Surgery, link.springer.ectes2016. Eur J Trauma Emerg Surg (2016) 42 (Suppl 2):S9–S245, DOI 10.1007/s00068-016-0658-5

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nasr, M.M. An Innovative Emergency Laparoscopic Cholecystectomy Technique; Early Results Towards Complication Free Surgery. J Gastrointest Surg 21, 302–311 (2017). https://doi.org/10.1007/s11605-016-3308-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3308-7

Keywords

Search

Navigation