Skip to main content
SpringerLink
Log in

Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

An Erratum to this article was published on 13 November 2009

Abstract

Background

Over the last two decades, laparoscopic cholecystectomy has become the gold standard for treating cholecystolithiasis and an index operation for evaluation and assessment of laparoscopic surgical skills. Its wider application and continuous refinement have not been accompanied by a commensurate decrease in morbidity due to biliary, vascular, or visceral injuries. Use of an energy source, especially monopolar electrosurgery, has been identified as a culprit for many of these injuries. This study assessed the feasibility of performing laparoscopic cholecystectomy safely without using any energy source by taking advantage of the avascular anatomical planes.

Method

Patients attending the surgery clinic of our center who were candidates for a laparoscopic cholecystectomy were enrolled. Informed consent was obtained from each patient before the procedure. The study was approved by the Ethical Review Board of the hospital and was conducted as per GCP guidelines.

Results

Between June 2005 and July 2006, 83 patients were enrolled. All patients underwent laparoscopic cholecystectomy without any energy source being used. There was no incidence of biliary, vascular, or visceral injury. All patients remained hemodynamically stable. There was no conversion or mortality. The hospital stay was 8–16 h. Patients were followed up by telephone for the first 48 hours and then by regulat outpatient visits until they were well.

Conclusion

A safe laparoscopic cholecystectomy without using any energy source can be performed by following the proper anatomical footprint.

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.

Similar content being viewed by others

References

  1. Litynski GS (1999) Profiles in laparoscopy: Mouret, Dubois and Perissat: the laparoscopic breakthrough in Europe (1987–1988). JSLS 3: 163–167

    CAS  PubMed  Google Scholar 

  2. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161: 385–387

    Article  CAS  PubMed  Google Scholar 

  3. Tang B, Hanna GB, Joice P, Cuschieri A (2004) Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg 139: 1215–1220

    Article  CAS  PubMed  Google Scholar 

  4. Tebala GD (2006) Three-port laparoscopic cholecystectomy by harmonic dissection without cystic duct and artery clipping. Am J Surg 191: 718–720

    Article  PubMed  Google Scholar 

  5. Shamiyeh A, Wayand W (2004) Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg 389: 164–171

    Article  CAS  PubMed  Google Scholar 

  6. Schmidt SC, Langrehr JM, Hintze RE, Neuhaus P (2005) Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg 92: 76–82

    Article  CAS  PubMed  Google Scholar 

  7. Kern KA (1997) Malpractice litigation involving laparoscopic cholecystectomy: cost, cause and consequences. Arch Surg 132: 392–398

    CAS  PubMed  Google Scholar 

  8. Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93: 158–168

    Article  CAS  PubMed  Google Scholar 

  9. Izuishi K, Toyama Y, Nakano S, Goda F, Usuki H, Masaki T, Maeta H (2005) Preoperative assessment of the aberrant bile duct using multislice computed tomography cholangiography. Am J Surg 189: 53–55

    Article  PubMed  Google Scholar 

  10. Stiles BM, Adusumilli PS, Bhargava A, Fong Y (2006) Fluorescent cholangiography in a mouse model: an innovative method for improved laparoscopic identification of the biliary anatomy. Surg Endosc 20: 1291–1295

    Article  CAS  PubMed  Google Scholar 

  11. Hugh TB (2002) New strategies to prevent laparoscopic bile duct injury – surgeons can learn from pilots. Surgery 132: 826–835

    Article  PubMed  Google Scholar 

  12. Lee KT, Shan YS, Wang ST, Lin PW (2005) Verres needle decompression of distended gallbladder to facilitate laparoscopic cholecystectomy in acute cholecystitis: a prospective study. Hepatogastroenterology 52: 1388–1392

    PubMed  Google Scholar 

  13. Gallagher AG, McClure N, McGuigan J, Ritchie K, Sheehy NP (1998) An ergonomic analysis of the fulcrum effect in the acquisition of endoscopic skills. Endoscopy 30: 617–620

    Article  CAS  PubMed  Google Scholar 

  14. Hanna GB, Shimi SM, Cuschieri A (1998) Task performance in endoscopic surgery is influenced by location of the image display. Ann Surg 227: 481–484

    Article  CAS  PubMed  Google Scholar 

  15. Tucker RD (1995) Laparoscopic electrosurgical injuries: Survey results and their implications. Surg Laparosc Endosc 5: 311–317

    CAS  PubMed  Google Scholar 

  16. Sietses C, Eijsbouts QAJ, von Blomberg BME, Cuesta MA (2001) Ultrasonic energy vs monopolar electrosurgery in laparoscopic cholecystectomy. Surg Endosc 15: 69–71

    Article  CAS  PubMed  Google Scholar 

  17. Tang B, Hanna GB, Carter F, Adamson GD, Martindale JP, Cuschieri A (2006) Competence assessment of laparoscopic operative and cognitive skills: Objective structured clinical examination (OSCE) or observational clinical human reliability assessment (OCHRA). World J Surg 30: 527–534

    Article  CAS  PubMed  Google Scholar 

  18. Diamond T, Mole DJ (2005) Anatomical orientation and cross-checking – the key to safer laparoscopic cholecystectomy. Br J Surg 92: 663–664

    Article  CAS  PubMed  Google Scholar 

  19. Halstead W (1912) Bulletin of the John Hopkins Hospital 23: 191

  20. Voorhees JR, Cohen-Gadol AA, Laws ER, Spencer DD (2005) Battling blood loss in neurosurgery: Harvey Cushing’s embrace of electrosurgery. J Neurosurg 102: 745–752

    Article  PubMed  Google Scholar 

  21. Adkins RB Jr, Chapman WC, Reddy VS (2000) Embryology, anatomy, and surgical applications of the extrahepatic biliary system. Surg Clin North Am 80: 363–379

    Article  PubMed  Google Scholar 

  22. Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S (2000) Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply. Surg Endosc 14: 141–144

    CAS  PubMed  Google Scholar 

  23. Yau HMP, Lee KT, Kao EL, Chuang HY, Chou SH, Huang MF (2005) Color Doppler ultrasound detection and classification of the tangential hepatic vein before laparoscopic cholecystectomy. Surg Endosc 19: 1377–1380

    Article  PubMed  Google Scholar 

  24. Aggarwal R, Moorthy K, Darzi A (2004) Laparoscopic skills training and assessment. Br J Surg 91: 1549–1558

    Article  CAS  PubMed  Google Scholar 

  25. Gray SM (2006) Knowledge management: a core skill for surgeons who manage. Surg Clin North Am 86: 17–39

    Article  PubMed  Google Scholar 

  26. Barrat C, Capelluto E, Champault G (1999) Intraperitoneal thermal variation during laparoscopic surgery. Surg Endosc 13: 136–138

    Article  CAS  PubMed  Google Scholar 

  27. Shen BY, Li HW, Chen M, Zheng MH, Zang L, Jiang SM, Li JW, Jiang Y (2003) Color Doppler ultrasonographic assessment of the risk of injury to major branch of the middle hepatic vein during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2: 126–130

    PubMed  Google Scholar 

  28. Meakins JL (2006) Evidence-based surgery. Surg Clin North Am 86: 1–16

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Sir Alfred Cuschieri for the encouragement he gave during the presentation of this technique at the Berlin Congress. They thank Dr. Bhawana Awasthy, Pooja Pant, Krishna Adit Agarwal, and Nayan Agarwal for their editorial assistance and Rajesh Taneja for technical support in photography.

Author information

Authors and Affiliations

  1. Department of General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India

    Brij Agarwal, Manish Gupta & Krishan Mahajan

  2. Department of Anatomy, Lady Hardinge Medical College, New Delhi, 110001, India

    Sneh Agarwal

Authors
  1. Brij Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manish Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sneh Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Krishan Mahajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brij Agarwal.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-009-0717-7

Rights and permissions

Reprints and permissions

About this article

Cite this article

Agarwal, B., Gupta, M., Agarwal, S. et al. Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique. Surg Endosc 21, 2154–2158 (2007). https://doi.org/10.1007/s00464-007-9320-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9320-y

Keywords

Search

Navigation