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Cawich, Shamir O., Carlos Wilson, Lindberg K. Simpson, and Akil J. Baker. "Stump Cholecystitis: Laparoscopic Completion Cholecystectomy with Basic Laparoscopic Equipment in a Resource Poor Setting." Case Reports in Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/787631.
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Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible.Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed.Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach.
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Hussain, Zahur, Himanshu Sharma, Vikrant Singh Chandail, et al. "LAPAROSCOPIC COMPLETION CHOLECYSTECTOMY FOR POST CHOLECYSTECTOMY SYNDROME." Journal of Evolution of Medical and Dental Sciences 4, no. 42 (2015): 7258–62. http://dx.doi.org/10.14260/jemds/2015/1054.
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Manish, Kumar, Kumar Prashant, and Narain Chandramohan. "Laparoscopic Completion Cholecystectomy: A Retrospective Study." International Journal of Pharmaceutical and Clinical Research 16, no. 6 (2024): 1379–82. https://doi.org/10.5281/zenodo.12741632.
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<strong>Background:</strong> Laparoscopic completion cholecystectomy (LCC) is a surgical procedure performed on patients who have previously undergone a partial cholecystectomy. This study aims to evaluate the outcomes and complications associated with LCC in a series of 40 cases at Netaji Subhash Medical College, Bihta, Patna, from January 2024 to May 2024. <strong>Materials and Methods:</strong> A retrospective analysis was conducted on 40 patients aged 50-65 years who underwent LCC between January 2024 and May 2024. Data were collected from medical records, including patient demographics, indications for surgery, intraoperative findings, operative time, postoperative complications, and hospital stay duration. Statistical analysis was performed to assess the correlation between patient characteristics and surgical outcomes. <strong>Results:</strong> Out of the 40 patients, 25 were male, and 15 were female. The mean operative time was 90 minutes (range: 75-120 minutes). The most common indication for LCC was residual gallbladder stones, accounting for 70% of the cases. Intraoperative complications occurred in 10% of the cases, with bile duct injury being the most significant complication. Postoperative complications were observed in 15% of the patients, including wound infection (5%) and bile leakage (10%). The average hospital stay was 4 days (range: 3-7 days). No mortality was reported in this series. <strong>Conclusion:</strong> Laparoscopic completion cholecystectomy is a feasible and safe procedure with acceptable morbidity rates. It is a viable option for patients with residual gallbladder disease following partial cholecystectomy. Proper patient selection and surgical expertise are crucial for minimizing complications and ensuring favorable outcomes.
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Elnabi, Mahmoud H., Ramy A. Hassan, Hamada F. A. Soliman, and Moamen S. Abdelgawaad. "Laparoscopic completion cholecystectomy for patients with residual gallstone disease: a single-center experience." Egyptian Journal of Surgery 42, no. 3 (2023): 635–41. http://dx.doi.org/10.4103/ejs.ejs_123_23.
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Background The incidence of residual gallbladder after cholecystectomy procedures may reach 2.5%. That remnant part of the gallbladder may harbor or develop stones, leading to recurrent symptoms. Surgical excision is recommended in such patients. Herein, we describe our experience regarding laparoscopic management of patients with residual gallbladder or cystic duct stump stones. Patients and methods We retrospectively reviewed the data of 24 patients with previous diagnosis, who were managed by laparoscopy in our tertiary-care setting. Relevant preoperative, intraoperative, and postoperative data were collected. Results The time interval since the previous cholecystectomy ranged between 3 and 120 months. Most patients had previously undergone an open cholecystectomy (75%), while the remaining cases were performed through laparoscopy. The laparoscopic assessment revealed residual gallbladder and cystic duct stump stones in 87.5% and 12.5% of cases, respectively. Conversion to the open approach was needed only in two cases (8.3%). Operative time ranged between 60 and 130 min (mean = 108.83), while intraoperative blood loss had a mean value of 111.88 mL (range, 50–150). The duration of hospitalization ranged between 1 and 4 days (median = 1). Postoperative morbidity occurred in eight patients (33.33%). Wound infection, gallbladder bed collection, and pulmonary embolism occurred in 16.7, 16.7, and 4.2% of patients, respectively. No specific risk factors for postoperative morbidity were identified. Conclusion Laparoscopic completion cholecystectomy is considered a safe and effective procedure in experienced hands for managing patients with symptomatic gallbladder residuals .
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Alsinan, Fatima, and Ali Alaqoul. "Laparoscopic Completion Cholecystectomy for Symptomatic Remnant Gallbladder Following Subtotal Cholecystectomy: a Report of Two Cases." Acta Informatica Medica 33, no. 1 (2025): 79. https://doi.org/10.5455/aim.2025.33.79-81.
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Background: Subtotal cholecystectomy (SC) is considered a safe option for a bailout in the presence of a difficult laparoscopic cholecystectomy with a low incidence of complications. Objective: This report aims to describe the challenges in diagnosing and managing remnant gallbladder. Case presentation: Case 1 is a 31-year-old male who presented with right upper quadrant abdominal pain ten years following SC. Abdominal ultrasound (US) and computed tomography (CT) scan confirmed a ruminant gallbladder. He underwent successful completion of laparoscopic cholecystectomy. Case 2 is a 40-year-old male who was admitted as a case of ascending cholangitis. He had a history of subtotal cholecystectomy one year prior to his presentation. CT scan, Magnetic resonance cholangiography (MRCP), and US all confirmed the presence of a remnant gallbladder. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), followed by the completion of laparoscopic cholecystectomy. Conclusion: Recurring symptoms due to the remnant gallbladder are often challenging to diagnose and treat. Herein, we highlight the importance of adequate preoperative investigations and surgical planning prior to intervention.
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Maharjan, Dhiresh Kumar, and Prabin Bikram Thapa. "Laparoscopic Extended Cholecystectomy for Early Gall Bladder Cancer." Journal of Nepal Health Research Council 18, no. 4 (2021): 724–28. http://dx.doi.org/10.33314/jnhrc.v18i4.2642.
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Background: Laparoscopic approach for early gall bladder cancer (T1b and T2) has been seen to have equal or better early outcomes and late outcomes in terms of overall survival rate and recurrence rate.Methods: This is a prospective cross sectional observational study performed including all consecutive patients who were diagnosed with gall bladder cancer by a single surgical team from August 2018 to February 2020 at Kathmandu Medical College Teaching Hospital or referred from outside for completion extended cholecystectomy where laparoscopic cholecystectomy was done in some other centre.Results: The mean age of the patients was 51.01±9.42 years in the laparoscopic extended cholecystectomy (N=10) group and 49.6±8.35 years in the open extended cholecystectomy (N=10) group (p value=0.711). Conversion rate was 20% in laparoscopic group. The operative time was longer in the laparoscopic group (287 +/-66.50 minutes, 120.0 to 446 minutes vs. 200+/-66.50 minutes, 100 to 405.0 minutes; p< 0.004.However, the laparoscopic extended cholecystectomy group showed faster time to oral intake and time to first passage of flatus and had shorter hospital stay by 2.2 days (4.8+/-0.78 days) than open approach 7+/-0.81 days.(p value=0.00).There were no significant differences between the groups in the tumour size (p=0.079) and number of harvested lymph nodes 9.3 (5 to 13) in laparoscopic group vs. 11.2 (8 to 15) in open extended cholecystectomy group (p=0.250).Conclusions: Laparoscopic extended cholecystectomy is feasible in early gall bladder cancer along with achievement of oncological safety.Keywords: Gall bladder cancer; laparoscopic extended cholecystectomy; open extended cholecystectomy
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Desai, Gunjan S., Prasad Pande, Rajvilas Narkhede, and Prasad Wagle. "Late postcholecystectomy Mirizzi syndrome due to a sessile gall bladder remnant calculus managed by laparoscopic completion cholecystectomy: a feasible surgical option." BMJ Case Reports 12, no. 8 (2019): e228156. http://dx.doi.org/10.1136/bcr-2018-228156.
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Postcholecystectomy Mirizzi syndrome (PCMS) is an uncommon entity that can occur due to cystic duct stump calculus, gall bladder remnant calculus or migrated surgical clip. It can be classified into early PCMS or late PCMS. It is often misdiagnosed and the management depends on the site of impaction of stone or clip. Endoscopy can be performed for cystic duct stump calculus. However, surgery is the treatment for remnant gall bladder calculus. Role of laparoscopic management is controversial. We present here a case of a 48-year-old woman with late PCMS due to an impacted calculus in a sessile gall bladder remnant following a subtotal cholecystectomy, managed with laparoscopic completion cholecystectomy, review the literature, provide tips for safe laparoscopy for PCMS and summarise our algorithmic approach to the management of the postcholecystectomy syndrome.
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Saeed, Anam, Mohammed Salim, Devi Singh Kachhawa, and Renuka Chaudhary. "Intra-operative factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center." International Surgery Journal 7, no. 5 (2020): 1467. http://dx.doi.org/10.18203/2349-2902.isj20201853.
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Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.
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Chandio, Ashfaq, Suzanne Timmons, Aamir Majeed, Aongus Twomey, and Fuad Aftab. "Factors Influencing the Successful Completion of Laparoscopic Cholecystectomy." JSLS : Journal of the Society of Laparoendoscopic Surgeons 13, no. 4 (2009): 581–86. http://dx.doi.org/10.4293/108680809x1258998404560.
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Gumbs, Andrew A., and John P. Hoffman. "Laparoscopic completion radical cholecystectomy for T2 gallbladder cancer." Surgical Endoscopy 24, no. 12 (2010): 3221–23. http://dx.doi.org/10.1007/s00464-010-1102-2.
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Borisov, A. E., L. A. Levin A. Levin, V. P. Zemlyanoi, N. I. Glushkov, Y. V. Levitina, and V. G. Medvedev. "Hepatocystic bile passages in laparoscopic cholecystectomy." Kazan medical journal 75, no. 2 (1994): 97–98. http://dx.doi.org/10.17816/kazmj89718.
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It is shown that the coagulation of bile passages does not prevent the outfrow of bile from them in postoperative period which is connected with real threat of the formation of bile flows with consequences of every description. The drainage of subhepatic space is an obligatory stage of the completion of laparoscopic cholecystectomy.
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Ahmed, Jashim Uddin, Kawsar Alam, Nasir Uddin, Md Nurul Hoque, and Taniza Jabin. "Post-cholecystectomy Syndrome Due To Stump-Stones: A Possibility." Journal of Chittagong Medical College Teachers' Association 25, no. 2 (2014): 49–53. http://dx.doi.org/10.3329/jcmcta.v25i2.61752.
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Recurrence of biliary symptoms following cholecystectomy either laparotomic or laparoscopic, is quite common. Causes are either biliary or extra-biliary. Symptoms of biliary origin chiefly depends on residual stones, biliary stricture, rarely depends on stones in cystic duct or gallbladder remnant. Diagnosis of stump-stones is difficult, mainly arising from USG, MRCP,CT-scan, ERCP. Completion cholecystectomy can be done by laparotomy or laparoscopically. We report two cases of stump-stones discovered after 10 years & 5 years following lap chole and minilap cholecystectomy respectively, who were diagnosed by USG, CT-scan and managed by open completion cholecystectomy. Stump-stones can be a possibility of post cholecystectomy syndrome even after 10 years and surgeons should be aware of it.
 JCMCTA 2014 ; 25 (2) : 49-53
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Parmar, Amit Kumar, Radha Govind Khandelwal, Mittu John Mathew, and Prasanna Kumar Reddy. "Laparoscopic completion cholecystectomy: A retrospective study of 40 cases." Asian Journal of Endoscopic Surgery 6, no. 2 (2012): 96–99. http://dx.doi.org/10.1111/ases.12012.
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Leesa Misra, Navya Teja, Swastik Mishra, and Manash Ranjan Sahoo. "Retaining the epigastric trocar, until rest all ports closed decreases post-operative shoulder pain in laparoscopic cholecystectomy patients." Asian Journal of Medical Sciences 14, no. 4 (2023): 219–21. https://doi.org/10.71152/ajms.v14i4.3754.
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Background: Laparoscopic cholecystectomy has become the mainstay of treatment for gallstone disease cases due to its lower morbidity and pain compared to open techniques. Unfortunately, the use of carbon dioxide to insufflate the abdomen is the main contributor to post-operative shoulder pain. Aims and Objectives: The aim of the study was to evaluate the effectiveness of retaining the epigastric port trocar in position until rest all ports closed after completion of lap cholecystectomy in decreasing the post-operative shoulder pain. Materials and Methods: A prospective, randomized, and clinical trial was done in AIIMS hospital, Bhubaneswar, on 102 patients who have undergone laparoscopic cholecystectomy. The patients were alternatively selected, one in the study group (52) and the other in the control group (50). For those patients in the study group, after the completion of the surgery, the epigastric port trocar is retained in position until the rest of all ports were closed. In the control group, all trocars were removed and port closure was done. The patients were evaluated for the next 24 h for post-operative shoulder pain. A numerical rating scale (NRS) was used to assess shoulder pain on patient arrival to the ward, at 4, 6, 12, and 24 h postoperatively. One hundred and two patients were included in the final data analysis. Results: NRS pain scores were significantly lower in the study group at 6, 12, and 24 h post-laparoscopic cholecystectomy compared to the control group with no additional requirement of IV analgesics. Conclusion: Retaining the epigastric trocar in position is an easy way that is beneficial in reducing post-operative shoulder pain post laparoscopic cholecystectomy surgery.
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Leesa Misra, Navya Teja, Swastik Mishra, and Manash Ranjan Sahoo. "Retaining the epigastric trocar, until rest all ports closed decreases post-operative shoulder pain in laparoscopic cholecystectomy patients." Asian Journal of Medical Sciences 14, no. 4 (2023): 219–21. http://dx.doi.org/10.3126/ajms.v14i4.51313.
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Background: Laparoscopic cholecystectomy has become the mainstay of treatment for gallstone disease cases due to its lower morbidity and pain compared to open techniques. Unfortunately, the use of carbon dioxide to insufflate the abdomen is the main contributor to post-operative shoulder pain. Aims and Objectives: The aim of the study was to evaluate the effectiveness of retaining the epigastric port trocar in position until rest all ports closed after completion of lap cholecystectomy in decreasing the post-operative shoulder pain. Materials and Methods: A prospective, randomized, and clinical trial was done in AIIMS hospital, Bhubaneswar, on 102 patients who have undergone laparoscopic cholecystectomy. The patients were alternatively selected, one in the study group (52) and the other in the control group (50). For those patients in the study group, after the completion of the surgery, the epigastric port trocar is retained in position until the rest of all ports were closed. In the control group, all trocars were removed and port closure was done. The patients were evaluated for the next 24 h for post-operative shoulder pain. A numerical rating scale (NRS) was used to assess shoulder pain on patient arrival to the ward, at 4, 6, 12, and 24 h postoperatively. One hundred and two patients were included in the final data analysis. Results: NRS pain scores were significantly lower in the study group at 6, 12, and 24 h post-laparoscopic cholecystectomy compared to the control group with no additional requirement of IV analgesics. Conclusion: Retaining the epigastric trocar in position is an easy way that is beneficial in reducing post-operative shoulder pain post laparoscopic cholecystectomy surgery.
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Daly, D., R. Gandy, and K. S. Haghighi. "Laparoscopic completion cholecystectomy for remnant gallbladder following previous incomplete cholecystectomy: a case series." HPB 18 (April 2016): e488. http://dx.doi.org/10.1016/j.hpb.2016.03.291.
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Mageed, Samir A. A., Mohammed A. Omar, and Alaa A. Redwan. "Remnant gall bladder and cystic duct stump stone after cholecystectomy: tertiary multicenter experience." International Surgery Journal 5, no. 11 (2018): 3478. http://dx.doi.org/10.18203/2349-2902.isj20184612.
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Background: There is no doubt that cholecystectomy relieves pre-surgical symptoms of gallbladder (GB) disease. The persistence of symptoms mainly biliary pain was recorded in 10 - 20% of cases, with variety of causes. Residual GB/cystic duct stump stone is one of the most important un-expected cause. The present study was conducted to study and evaluate those patients, with their surgical treatment.Methods: This retrospective study was conducted on 27 cases with residual GB/cystic duct stump stone. The diagnosis was guided by ultrasound and magnetic resonance cholangio-pancreatography. All cases were managed by using completion cholecystectomy - either open or laparoscopic. All preoperative, operative, and postoperative data were collected.Results: Preoperative endoscopic retrograde cholangio-pancreatography and papillotomy were required in 13 patients whom were presented with obstructive jaundice. Open completion cholecystectomy techniques were done in the majority of cases (21 patients) while laparoscopic approach was feasible in only 6 cases with one conversion (1/6). The mean operative time was (89.57 ± 12.05 and 118.16 ± 12.6 min), and the mean blood loss was (195.5 ± 19.22 and 187.5 ± 23.61 ml) respectively. Intra-operative minor biliary injury occurred in two cases and repaired instantaneously. The mean hospital stay was (4.76 ± 2.81 and 2.33 ± 1.32 days) respectively. All patients were reported to be symptom-free at the follow-up after surgical treatment.Conclusions: Residual GB/cystic duct stump stone is a preventable and correctable cause of post-cholecystectomy complaint. Completion cholecystectomy is a proven treatment of choice to relieve symptoms and avoid complications; furthermore, it can be carried out laparoscopically with experienced team and facilities in spite of difficulties.
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Kohn, Geoffrey P., and John B. Martinie. "Laparoscopic robot-assisted completion cholecystectomy: a report of three cases." International Journal of Medical Robotics and Computer Assisted Surgery 5, no. 4 (2009): 406–9. http://dx.doi.org/10.1002/rcs.270.
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Joshi, Mukund Raj, Tanka Prasad Bohara, Shail Rupakheti, and Deepak Raj Singh. "Single Stage Management of Concomitant Cholelithiasis and Choledocholithiasis." Journal of Nepal Medical Association 56, no. 205 (2017): 117–23. http://dx.doi.org/10.31729/jnma.2931.
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Introduction: Concomitant cholelithiasis and choledocholithiasis are commonly managed in two stage procedure, endoscopic management of common bile duct stone followed by laparoscopic cholecystectomy in different time and setting. We perform these two procedures in same sitting in operating room set up. We evaluated the procedure in terms of outcome, feasibility and complications.
 Methods: Prospective cross-sectional study carried out since April 2013 to August 2016 in all patients who had undergone single stage endoscopic and laparoscopic management of concomitant cholelithiasis and choledocholithiasis. Patient’s demography, procedural time for different procedure and procedure in total and post-operative complications were recorded and analyzed with suitable statistical methods.
 Results: Out of 50 cases enrolled, 2 patients were converted to open. Out of 48 patients, 3 needed re-attempt for completion. Majority were female 36 (72%), mean age was 39.48years. Mean common bile duct diameter and mean stone size was 11.43±2.63 cm and 7.99±2.01cm, respectively. Mean of total procedural time was 90.93± 33.68 minutes. In most of the cases, laparoscopic cholecystectomy performed first followed by endoscopic method (66.7%). Total procedural time was less in the patients who underwent laparoscopy first in comparison to endoscopy first. Clinically significant complications like cholangitis, pancreatitis and duodenal perforation occurred in 7 patients. Out of 4 patients who developed pancreatitis, one had severe acute pancreatitis requiring prolonged hospitalization.
 Conclusion: Single stage management of common bile duct and gall bladder stone by laparoscopic and endoscopic method is feasible in our setup with acceptable results. Endoscopic treatment of common bile duct stone if performed first, is associated with longer procedural time.
 Keywords: choledocholithiasis; cholelithiasis; endoscopic retrograde cholangiopancreatography; laparoscopic cholecystectomy.
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Kroh, Matthew, Sricharan Chalikonda, Bipan Chand, and R. Matthew Walsh. "Laparoscopic Completion Cholecystectomy and Common Bile Duct Exploration for Retained Gallbladder After Single-Incision Cholecystectomy." JSLS : Journal of the Society of Laparoendoscopic Surgeons 17, no. 1 (2013): 143–47. http://dx.doi.org/10.4293/108680812x13517013317356.
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Fayyaz, Ahmad Asad Tahir Ferhat Jabeen. "EFFICACY OF OBLIQUE SUBCOSTAL TRANSVERSE ABDOMINAL BLOCK IN LAPAROSCOPIC CHOLECYSTECTOMY." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES 05, no. 07 (2018): 6679–82. https://doi.org/10.5281/zenodo.1318673.
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<strong><em>Objective;</em></strong><em> To determine the efficacy of oblique subcostal transverse abdominal block in laparoscopic cholecystectomy. </em> <strong><em>Patients and methods;</em></strong><em> This was a descriptive case series study, which was conducted at Services hospital, Lahore during 01-07-2017 to 31-1-2018. In this study the cases of age 20 years or more of both genders undergoing laparoscopic cholecystectomy were included. The cases with end stage liver or renal failure were excluded. The oblique subcostal transverse abdominal block was </em><em>applied after completion of laparoscopic cholecystectomy, under the guidance of linear 5–12 MHz ultrasound transducer under aseptic measures. The block was made up of 50:50 mixture of bupivacaine 5 mg/ml and lignocaine 21 mg/ml and adrenaline 1:200,000. The efficacy was labelled as yes where the pain was < 3 on visual analogue scale assessed at 12 hours of surgery.</em> <strong><em>Results;</em></strong> <em>In this study there were total 40 cases undergoing laparoscopic cholecystectomy. Out of these, there were 28 (70%) were females and 12 (30%) were males. The mean age was 49.34</em><em>±6.39 years. The efficacy of oblique subcostal transverse abdominal block was seen in 26 (65%) of the cases. There was no significant difference in terms of gender between two groups with p= 0.95. The efficacy was near significantly better in cases with age less than 50 years where it was seen in </em><em>21 (70%) of cases with p= 0.13. There was also no significant difference in terms of duration of surgery with efficacy with p= 0.89.</em> <strong><em>Conclusion; </em></strong><em>Oblique subcostal transverse abdominal block has shown efficacy in around 2/3<sup>rd</sup> of cases and it is near significantly better in cases with age less than 50 years.</em> <strong>Key words; </strong><em>Subcostal, Cholecystectomy </em>
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Vidal, ÓScar, Mihai Pavel, Mauro Valentini, et al. "Single-Incision Laparoscopic Cholecystectomy for Day Surgery Procedure: Are We Prepared?" American Surgeon 78, no. 4 (2012): 436–39. http://dx.doi.org/10.1177/000313481207800434.
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Single-incision laparoscopic surgery (SILS) for cholecystectomy is a well-established procedure and represents the next step in developing the concept of fast track surgery. This report describes our experience with SILS cholecystectomy in patients that stay overnight. Between February 2009 and July 2010, patients referred for cholecystectomy to the day surgery unit who agreed to undergo SILS were included in a prospective study. All operations were performed by the same surgical team specially trained in this type of surgery and the same operative technique was used in all cases. Postoperative pain and nausea were assessed using a 10-cm visual analogue scale on a self-completion questionnaire on the night of operation and the morning of discharge. A total of 107 patients (58% women, mean age 56 years) with symptomatic gallstones were included in the study. SILS was successfully performed in all patients and no patient required conversion to an open procedure. There were no significant differences in the median visual analogue scale for postoperative pain and nausea between the night of surgery and the next morning. The mean length of hospital stay was 23 hours, and 98 per cent of patients were satisfied with the results of surgery and would be willing to undergo the same procedure again. SILS cholecystectomy is a valid alternative to standard laparoscopic cholecystectomy as an outpatient surgery or overnight stay procedure. According to these promising results, SILS cholecystectomy could be included in a major ambulatory surgery program.
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Baral, Bidur, and Puspa Raj Poudel. "Comparison of Analgesic Efficacy of Ultrasound Guided Subcostal Transversus Abdominis Plane Block with Port Site Infiltration Following Laparoscopic Cholecystectomy." Journal of Nepal Health Research Council 16, no. 41 (2019): 457–61. http://dx.doi.org/10.33314/jnhrc.v16i41.1486.
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Background: Patients have significant pain following laparoscopic cholecystectomy. Several modalities have been used to manage this pain. Subcostal transversus abdominis plane (TAP) block is one of the components of multimodal analgesia and has been described as an effective technique for postoperative pain management. This study compares the impact of subcostal TAP block with port site local infiltration following laparoscopic cholecystectomy for postoperative pain and opioid consumption.Methods: This is a prospective, randomized, interventional study. Sixty patients were enrolled and divided into two groups having 30 patients in each group. Group A received bilateral ultrasound guided subcostal TAP block with 10 mL of 0.25% bupivacaine after the completion of surgery. Group B received similar amount of local anesthetic infiltrated over all the laparoscopic port sites. Pain at rest and on movement was assessed using VAS scale in post-operative period at 0 min, 30 min, 2, 4, 6, 12 and 24 hours. Time of first rescue analgesic requirement and total opioid consumption over 24 hours were recorded.Results: Patients receiving Subcostal TAP block had reduced postoperative pain as compared to port site infiltration and statistically significantly in first two hours after surgery. The 24 hours opioids consumption was significantly less (125mg ±25.42 versus 175mg ±25.42, p <0.001) in Subcostal TAP block group. Time for request of first rescue analgesic was prolonged in patients receiving the Subcostal TAP block (3.20±0.84 hours vs 1.70±0.65 hours, p <0.001). Conclusions: Ultrasound guided bilateral Subcostal TAP block provides effective post-operative analgesia and reduces opioid consumption in patients undergoing laparoscopic cholecystectomy. Keywords: Laparoscopic cholecystectomy; post-operative analgesia; subcostal TAP block.
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Ferrarese, Alessia, Valentina Gentile, Marco Bindi, et al. "The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?" Open Medicine 11, no. 1 (2016): 489–96. http://dx.doi.org/10.1515/med-2016-0086.
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AbstractA well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient.Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy.Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress.Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.
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Cawich, S. O., S. K. Mohanty, D. Dan, et al. "Laparoscopic completion cholecystectomy: an audit from the caribbean chapter of the ahpba." HPB 20 (March 2018): S123. http://dx.doi.org/10.1016/j.hpb.2018.02.519.
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Zahedian, Ali, Sekineh Kamali Ahangar, and Yasser Asghari. "Post cholecystectomy syndrome need to redo laparoscopic completion surgery: A case report." International Journal of Surgery Case Reports 42 (2018): 145–47. http://dx.doi.org/10.1016/j.ijscr.2017.12.001.
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Shah, JN, SB Maharjan, S. Shah, et al. "Feasibility, safety and benefit of no drip after cholecystectomy: a prespective observational study." Health Renaissance 10, no. 3 (2012): 187–91. http://dx.doi.org/10.3126/hren.v10i3.7133.
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Background: traditionally intravenous fluid is continued after cholecystectomy till resumption of oral intake. This practice seems unnecessary given the fast recovery following uncomplicated cholecystectomy. Objective: To observe feasibility, safety and benefit of no drip after cholecystectomy. Methods: After ethical approval, one hundred cholecystectomy patients were prospectively enrolled in the study. Complicated gall stones were excluded. In consultation with anesthetists, intravenous fluid was calculated based on body weight, maintenance etc. and infused till completion of surgery. Drip was discontinued. Patients were shifted out of operation room with IV lock. Nurses, family members and patients were detailed about this change in practice. Patients were monitored as per our existing standard practice. Anesthetists compulsorily signed out patients to the ward. After 4 hours of surgery patients were encouraged to start oral fluid. Data on fluid requirement, post operative complications and satisfaction of patients were analyzed. Results: One hundred cholecystectomy patients were studied. Average age was 39.8 years, weight 57 kg. Female were 85. Elective cases were 86 and acute 14. Average surgery time was 66 minutes and fluid required was 1313 ml. Open cholecystectomy was 71, laparoscopic 28 and 1-conversion. One laparoscopic patient was reopened due to bleeding. Four patients required drip, 2 for low blood pressure, 1 for vomiting and 1 for low oral intake. There was no mortality in this series. All concerned welcomed this change in practice. Conclusion: discontinuing intravenous drip after uncomplicated cholecystectomy is safe, and well accepted by all concerned. DOI: http://dx.doi.org/10.3126/hren.v10i3.7133 Health Renaissance; September-December 2012; Vol 10 (No.3);187-191
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Amrit, Kumar, and Nath Vikram. "A Hospital Based Randomized Comparative Assessment of Laparoscopic Cholecystectomy under Spinal Anaesthesia vs General Anaesthesia." International Journal of Current Pharmaceutical Review and Research 15, no. 10 (2023): 243–48. https://doi.org/10.5281/zenodo.11623114.
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AbstractAim: The aim of the present study was to evaluate the efficacy, safety and advantages of conducting LC underSA in comparison to GA.Methods: The study was conducted in the Department of Anaesthesia for 8 months . Informed consent wasobtained from all the patients who had agreed to participate in the study. A detailed explanation of the procedureand risks involved was given. A total number of 70 patients were included in the study.Results: Both the groups had similar demographic profile. In the SA group, 45 patients were females and 25patients were males. The mean age was 46 ±12.68 years and 48.82 ±10.45 in SA and GA groups respectively.The duration of surgery was 82.98±21.99 min and 98.2±36.04 min in the GA and SA groups which was notstatistically significant. For each procedure the surgeon was asked to give a score of 1-3, regarding the surgicalconditions and muscle relaxation; 1 was bad, 2 good and 3 being excellent. In the SA group, 8 patientscomplained of shoulder pain, 3 patients required conversion to GA as the pain did not subside with Fentanyl andthey were excluded from further analysis. All the patients (100%) in the GA group had pain at operated siteimmediately after completion of operation and their pain score ranged from 4-7, all patients received rescueanalgesic before shifting to the ward. In the first 24h tramadol required as rescue in the GA group was 84±26mg which was significantly higher than the SA group requiring only 31±32.18 mg. Although, the GA group hadmore patients experiencing postoperative nausea & vomiting it was not statistically significant.Conclusion: We concluded that laparoscopic cholecystectomy can be safely performed under spinal anaesthesiausing bupivacaine and clonidine as an adjuvant. Spinal anaesthesia provides stable intra-operativehaemodynamic and respiratory parameters, requires less postoperative analgesics with extended duration ofanalgesia, with no major complications and has better patient satisfaction
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Dr, Hina Iftikhar Dr Asim Raza Mir Shah Dr komal Naseer. "A STUDY ON THE SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES o6, no. 03 (2019): 6212–15. https://doi.org/10.5281/zenodo.2603954.
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<strong><em>Objective: </em></strong><em>Single incision laparoscopic surgery (SILS) is one of the most acceptable methods of all population. First advantage of the surgery is unseen defect. The aims of our research study to show the first skill of this surgery with all population.</em> <strong><em>Methodology: </em></strong><em>This method of surgery was applied on thirty patients who suffer from gallstones in Mayo Hospital Lahore from October 2017 to April 2018</em><em>. The data collected prospectively included age, gender, operative duration, difficulty, pain and reason for conversion.</em> <strong><em>Results: </em></strong><em>In 30</em><em> SILS cases twenty-seven were well done. 80 minutes was the mean operative duration of this surgery (ranges 50-180min). Three participant required more ports for the completion of surgery. All participant of this method were discharged from hospital on second day of surgery one patient were remain due to intestinal pain. That participant was discharged from hospital on sixth day of surgery. In two patients we had seen soft infected wound. One patient was exposes for pain study. </em> <strong><em>Conclusion: </em></strong><em>SILS cholecystectomy is a protected, feasible and without seen defect surgery if it was done on senior laparoscopic specialist first we need more information about this method.</em> <strong>Key Words: </strong><em>Prospectively, Laparoscopic, cholecystectomy, Participant, Nephrectomies, Urological</em>
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Indranil Chakraborty, Manojit Sarkar, Arup Kumar Ghosh, and Amit Ray. "A prospective and retrospective observational study on residual gallbladder stones after cholecystectomy." Asian Journal of Medical Sciences 15, no. 12 (2024): 210–16. https://doi.org/10.3126/ajms.v15i12.67264.
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Background: A small number of post-cholecystectomy syndrome cases result from residual stones in a lengthy cystic duct or recurrence of lithiasis in a remaining gallbladder (GB) tissue. In laparoscopic procedures, up to 13.3% may involve incomplete GB removal due to surgical complexities and anatomical variations such as adhesions or challenging morphology. Aims and Objectives: (1) To assess the incidence of retained stones in patients undergoing cholecystectomy, (2) to compare incidences among open and laparoscopic cholecystectomies, (3) to study various presenting ways and different investigational methods helping in early diagnosis and proper management, and (4) to study different operative interventions for different cases. Materials and Methods: This was a prospective and retrospective observational study. After getting ethical committee approval and informed consent, 35 patients were included in the study. The study was carried out in the Department of General Surgery at I.P.G.M.E.R./S.S.K.M. Hospital, Kolkata. Results: Most patients were post-open cholecystectomy cases. The incidence of retained GB stones was 4.48%, with females affected 2.8 times more than males. Common symptoms were pain abdomen (80%) and fever (25%). Ultrasonography diagnosed stump calculi in 85.71% of cases; magnetic resonance cholangiopancreatography (MRCP) was preferred when ultrasound was inconclusive. Conclusion: Cases underwent subtotal cholecystectomy or had long cystic duct stumps in rural hospitals, referred to tertiary hospital for further management. Symptoms included pain abdomen, fever, and sometimes jaundice. MRCP confirmed diagnoses before open re-exploration; completion cholecystectomy addressed residual stones for symptom relief and cure.
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Indranil Chakraborty, Manojit Sarkar, Arup Kumar Ghosh, and Amit Ray. "A prospective and retrospective observational study on residual gallbladder stones after cholecystectomy." Asian Journal of Medical Sciences 15, no. 12 (2024): 210–16. https://doi.org/10.71152/ajms.v15i12.4079.
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Background: A small number of post-cholecystectomy syndrome cases result from residual stones in a lengthy cystic duct or recurrence of lithiasis in a remaining gallbladder (GB) tissue. In laparoscopic procedures, up to 13.3% may involve incomplete GB removal due to surgical complexities and anatomical variations such as adhesions or challenging morphology. Aims and Objectives: (1) To assess the incidence of retained stones in patients undergoing cholecystectomy, (2) to compare incidences among open and laparoscopic cholecystectomies, (3) to study various presenting ways and different investigational methods helping in early diagnosis and proper management, and (4) to study different operative interventions for different cases. Materials and Methods: This was a prospective and retrospective observational study. After getting ethical committee approval and informed consent, 35 patients were included in the study. The study was carried out in the Department of General Surgery at I.P.G.M.E.R./S.S.K.M. Hospital, Kolkata. Results: Most patients were post-open cholecystectomy cases. The incidence of retained GB stones was 4.48%, with females affected 2.8 times more than males. Common symptoms were pain abdomen (80%) and fever (25%). Ultrasonography diagnosed stump calculi in 85.71% of cases; magnetic resonance cholangiopancreatography (MRCP) was preferred when ultrasound was inconclusive. Conclusion: Cases underwent subtotal cholecystectomy or had long cystic duct stumps in rural hospitals, referred to tertiary hospital for further management. Symptoms included pain abdomen, fever, and sometimes jaundice. MRCP confirmed diagnoses before open re-exploration; completion cholecystectomy addressed residual stones for symptom relief and cure.
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Ramadan, Saleem, Mohammad Abu-Shams, Sameer Al-Dahidi, Ibrahim Odeh, and Najat Almasarwah. "A data-driven approach for predicting remaining intra-surgical time and enhancing operating room efficiency." Journal of Industrial Engineering and Management 18, no. 1 (2025): 145. https://doi.org/10.3926/jiem.8543.
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Purpose: Efficient scheduling in Operating Rooms (ORs) is essential for optimizing corresponding costs and enhancing customer satisfaction in healthcare systems.Design/methodology/approach: Conventional static scheduling methods rely on fixed historical surgery times and often lead to inefficient resource utilization and increased costs due to inaccurate predictions of surgical durations. In this regard, this paper introduces an innovative method that employs Convolutional Neural Networks (CNNs) to predict the remaining intra-surgical time through binary classification for the Gallbladder Dissection phase and to dynamically manage OR schedules. The study, although focused on laparoscopic cholecystectomy procedures, demonstrates a method adaptable to other laparoscopic surgeries. The dataset comprises labeled laparoscopic cholecystectomy videos (time labels for different phases) used to train and evaluate the CNN.Findings: Results show that the proposed method reduces patient waiting times by an average of 87.3% and eliminates OR idle time compared to traditional fixed-time scheduling methods.Originality/value: The innovative aspect of this study lies in the use of CNNs to forecast surgery completion times, enabling nurses to prepare the next patient promptly and allowing for dynamic rescheduling when surgeries run late or finish early. This combination significantly improves OR utilization efficiency and boosts patient satisfaction.
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Krishnamurthy, Gautham, Jayapal Rajendran, Vishal Sharma, Hemanth Kumar, and Harjeet Singh. "Incidental peritoneal tuberculosis: surgeon’s dilemma in endemic regions." Therapeutic Advances in Infectious Disease 5, no. 5 (2018): 97–102. http://dx.doi.org/10.1177/2049936118783687.
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Background: Peritoneal tuberculosis has varying clinical manifestations. The study was conducted to highlight the entity of incidental peritoneal tuberculosis. Diagnostic and therapeutic dilemma is likely to occur on detection of unexpected peritoneal nodules. Materials and methodology: Incidental peritoneal tuberculosis was defined as peritoneal tuberculosis (peritoneal tubercles or ascites) detected intraoperatively in patients undergoing surgical exploration for other indications with no preoperative suspicion of abdominal tuberculosis or active tubercular lesions anywhere in the body. Retrospective analysis of patients operated in our department from June 2016 to November 2017 was performed. Results: Of the 409 patients operated, 5 patients (1.2%) had incidental peritoneal tuberculosis. The primary indication of surgery was laparoscopic cholecystectomy in three, restoration of bowel continuity in one and laparoscopic appendectomy in one. Two patients had remote history of antitubercular therapy for pulmonary and nodal tuberculosis, respectively. The three patients planned for laparoscopic cholecystectomy had their procedures deferred on suspicion of peritoneal carcinomatosis. Subsequently, all the three underwent cholecystectomy after completion of antitubercular treatment. None of the resected specimen (gallbladder/appendix/colon) had evidence of tuberculosis (acid fast bacilli positive or caseating granuloma). Antitubercular treatment for 6 months was completed in all the patients with active peritoneal disease. Conclusion: Incidental peritoneal tuberculosis represents an uncommon form of peritoneal tuberculosis. Absence of prior tuberculosis does not preclude the diagnosis of peritoneal tuberculosis. In an endemic region of tuberculosis, surgeons must be aware of the entity on encountering such finding. Frozen section can help in guiding appropriate management.
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Ocal, Ibrahim, Mustafa Ocal, Atilla Genc, and Atilla Badem. "Laparoscopic cholecystectomy: Assessing the operation outcomes of a single surgeon in his first two years." Medicine Science | International Medical Journal 14, no. 1 (2025): 43. https://doi.org/10.5455/medscience.2024.11.143.
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Laparoscopic cholecystectomy (LC) has solidified its role as the gold standard for managing symptomatic gallstones, acclaimed for its short hospital stay, quick recovery, minimal trauma, and less need for postoperative pain management. This study aims to address potential trust issues related to LC procedures and the surgeon by evaluating the overall conditions and outcomes of patients who underwent laparoscopic cholecystectomy at a single center by a single doctor within two years following the completion of their specialty training. The goal is to assess and establish the reliability of LC applications and the surgeon's competency in a practical setting. This retrospective study analyzed hospital records from 2021 to 2023, involving patients who underwent laparoscopic cholecystectomy performed by a single surgeon who completed his specialty training two years prior. The study comprehensively evaluated the medical files of 253 patients treated by this surgeon. Key findings reveal an average surgery time of 37.9 minutes-significantly less than commonly cited durations in medical literature. The study also reported a notably low conversion rate to open surgery at 2.4%, which underscores the safety and feasibility of LC even in complicated cases like acute cholecystitis. While complications were minimal, the occurrence of bile duct injuries at a rate of 3.1% suggests the need for improved training and preventive protocols. This research emphasizes the critical role of continual training and experience for young surgeons, aiming to bolster public confidence in their capabilities and promoting wider acceptance of minimally invasive surgical techniques.
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Aloraini,, Abdullah, Khaled Alshehri, Rahaf Alshammari,, et al. "Late port-site metastasis of unexpected gallbladder carcinoma after laparoscopic cholecystectomy: A case report." Medicine 103, no. 18 (2024): e37880. http://dx.doi.org/10.1097/md.0000000000037880.
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Introduction: Incidental gallbladder carcinoma refers to a discovery of gallbladder cancer during or after cholecystectomy. Late port-site metastasis (PSM) following Laparoscopic cholecystectomy (LC) is rare with an incidence rate of 10.3%. Patient concerns: We report a case of a 58-year-old man who presented with a painful abdominal wall mass for 6 weeks. He had a history of LC for symptomatic cholelithiasis, 8 years prior. Diagnosis: Histopathological examination revealed a positive result for metastatic adenocarcinoma from the abdominal wall mass. Moreover, Positron emission tomography (PET) showed a small focus of intense fluorodeoxyglucose (FDG) uptake in the gallbladder bed, which was highly suspicious for malignancy. Intervention: Decision was to proceed with surgery owing to uptake in the gallbladder bed with single-site metastasis to the previous port site. In addition, in the board meeting, an agreement was reached for performing distal pancreatectomy with splenectomy owing to uncertainty of malignancy based on what was discovered during the full metastatic workup. Diagnostic laparoscopy followed by midline laparotomy performed. Radical completion cholecystectomy with lymphadenectomy was done. Followed by complete resection of the anterior abdominal wall. Distal pancreatectomy and splenectomy were then performed. Outcome: Pathological diagnosis showed metastatic/invasive, moderately differentiated adenocarcinoma with positive margins on the posterior surface of excised port-site mass. The positive margins necessitated further chemoradiotherapy, followed by adjuvant chemotherapy until lung metastasis was identified. After this, the patient was scheduled for palliative chemotherapy. Conclusion: Presence of PSM is often associated with peritoneal metastasis. For this reason, it is advised to evaluate the patient for possible metastasis.
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Golod, Nataliya R., Igor K. Churpiy, Olesia V. Yaniv, et al. "The Influence of the Application of Mineral Water on the Functional State of the Liver of Patients after Laparoscopic Cholecystektomia in the Long Period of Rehabilitation." Acta Balneologica 64, no. 1 (2022): 29–33. http://dx.doi.org/10.36740/abal202201106.
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Aim: To determine the effectiveness of the influence of the use of mineral medicinal water on the functional state of the liver of patients after laparoscopic cholecystectomy in a long period of rehabilitation in the conditions of the Morshynkurort health resort complex. Materials and Methods: An analysis of 100 medical records of patients after laparoscopic cholecystectomy who were undergoing rehabilitation at the Morshynkurort health resort complex in 2017 and 2018 was carried out. Medical records were selected by a randomized method using the Random Allocation Rule program. Blinded evaluators while processing medical records. The method of comparison of indicators of the functional state of the liver of patients before the beginning of rehabilitation and after its completion was carried out by the method of mathematical statistics – Student’s t-test. The studied parameters: total protein (g/l), thymol test (unit), total bilirubin (mkmol/l), activity of alanine transpeptidase (ALT, (units/hour • l)), aspartate transaminase (AST, (units/hour • l)), total cholesterol (mmol/l), triglycerides (mmol/l), blood glucose (mmol/l). All patients were examined before and after treatment. There was no dropout from the study among the surveyed. Results: Mathematical statistics revealed a significant (p <0,05) improvement in such indicators as: thymol test, alanine transpeptidase activity, total cholesterol. Conclusions: Hydrotherapy for 14 days MPO well No. 3-k and groundwater source No. 4 in Morshyn diluted to mineralization 3,0-3,4 g/dm³ at a long stage of rehabilitation leads to an improvement in liver function in patients after laparoscopic cholecystectomy.
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Zhu, Gina, Kelli Ann Ifuku, and Kimberly S. Kirkwood. "Robotic-assisted approach for complex cholecystectomies." Mini-invasive Surgery 7 (2023): 12. http://dx.doi.org/10.20517/2574-1225.2022.117.
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Robotic approaches have facilitated the minimally invasive completion of increasingly complex surgical procedures. In the management of the difficult gallbladder, we have found that the wristed instruments, three-dimensional camera, the ability to use indocyanine green (ICG) with integrated fluorescent imaging, and ease of intracorporeal suturing to be useful in tackling the challenges associated with complex benign gallbladder disease. We describe the rationale and technical lessons learned during four cases of complex cholecystectomies that highlight the management principles and technical advantages afforded by the use of the robotic-assisted laparoscopic (RAL) approach. The cases include a subtotal fundus-first reconstituting cholecystectomy, subtotal fenestrating cholecystectomy, a cholecystocolonic fistula managed by a RAL subtotal fenestrating cholecystectomy, and an iatrogenic cholecystoduodenal fistula managed by RAL cholecystectomy. In each case, the operation was performed safely without intraoperative injury or conversion to open, and three of the four patients were discharged from the recovery room. In our view, these favorable outcomes were greatly facilitated by the robotic platform. It is our intent to share adaptations and innovations that we found helpful to encourage other surgeons with sufficient robotic experience to tackle complex gallbladder cases minimally invasively.
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Kamal, Muhammad Aizaz, Waseem Yar Khan, Sana Arooj, Muhammad Yaseen Khan, Muhammad Imran, and Shafia Qazi. "Comparison of Subcutaneous Infiltration With Intraperitoneal Instillation of Bupivacaine in Reduction of Early Postoperative Pain After Laparoscopic Cholecystectomy." Biological and Clinical Sciences Research Journal 6, no. 3 (2025): 101–4. https://doi.org/10.54112/bcsrj.v6i3.1632.
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Postoperative pain remains a significant concern following laparoscopic cholecystectomy. Bupivacaine, a long-acting local anesthetic, is commonly used through different administration routes to reduce early postoperative pain. Determining the most effective delivery method may enhance recovery and improve patient comfort. Objective: To compare the effectiveness of subcutaneous infiltration versus intraperitoneal instillation of bupivacaine in reducing early postoperative pain following laparoscopic cholecystectomy. Methods: A quasi-experimental study was conducted at the Department of General Surgery, Qazi Hussain Ahmad Medical Complex, Nowshera, from December 2022 to June 2023. Sixty-two patients meeting the inclusion criteria were randomly assigned to two equal groups. Group A received 20 ml of 0.25% bupivacaine via subcutaneous infiltration at port sites, while Group B received the same dose intraperitoneally before the completion of the procedure. Pain intensity was assessed at 1, 4, 8, 12, and 24 hours postoperatively using the Visual Analogue Scale (VAS). Data were analyzed using SPSS Version 25, with p-values ≤0.05 considered statistically significant. Results: The mean age of participants was 45.92 ± 8.73 years. Gender distribution included 30 (51.6%) males and 32 (48.4%) females. No significant differences in age (p = 0.31) or gender (p = 0.22) were observed between groups. At 1 hour postoperatively, Group A had a higher mean VAS score (7.45 ± 0.89) compared to Group B (5.64 ± 0.84) (p = 0.00). At 24 hours, pain scores remained significantly lower in Group B (1.65 ± 0.61) compared to Group A (2.29 ± 0.86) (p = 0.00). Conclusion: Both subcutaneous infiltration and intraperitoneal instillation of bupivacaine effectively reduce early postoperative pain following laparoscopic cholecystectomy. However, intraperitoneal instillation provides significantly superior pain control at both early and later postoperative periods.
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Shruthi R and Achyutha Setty Jutoor. "A randomised, prospective, double blind study of intraperitoneal instillation of 0.25% bupivacaine with clonidine versus 0.25% bupivacaine with dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy." Indian Journal of Clinical Anaesthesia 10, no. 3 (2023): 264–68. http://dx.doi.org/10.18231/j.ijca.2023.054.
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Laparoscopic cholecystectomy is the standard and most accepted technique for Cholecystectomies due to lesser postop pain and short recovery time.The origin of abdominal and shoulder pain after laparoscopic procedures has led to the use of intra peritoneal instillation of local anaesthetic agent to reduce postoperative pain. To assess the efficacy and quality of postoperative analgesia between the study groups using Visual Analogue Scale (VAS) score at various time intervals along with side effects if any.: 60 patients belonging to ASA 1 and 11 categories posted for Laparoscopic Cholecystectomy were given General Anaesthesia. After completion of surgery, before removing the trocar, anaesthetic study solution was sprayed on the surface of liver, gall bladder bed, right sub-diaphragmatic space, and port sites in Trendelenburg position. Volume and dilution of two drugs were same in both groups. Bupivacaine (0.25%) 50 mL; Dexmedetomidine (1 µg/kg) (BD) or Clonidine (1 µg/kg) (BC) was used. VAS score, Heart rate and BP measured at various time intervals and the time of first rescue analgesia noted.: VAS of BD group was 5.27 ± 0.64 to 3.70 ± 0.837 from 1 hour to 6 hour post extubation, when compared to BC group of 6.03 ± 0.669 in 1 hour reduced to 4.17 ± 0.699 at 6 hour post extubation. Dexmedetomidine combination significantly reduced the total dose of rescue analgesic required in 24 hours as compared to Clonidine combination.
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Das, Chittaranjan, Suzon Kumar Mazumder, and Md Ibrahim Siddique. "Modified Open Technique for First Port Insertion in Laparoscopic Surgery." Bangladesh Medical Journal 52, no. 2 (2024): 11–14. http://dx.doi.org/10.3329/bmj.v52i2.73768.
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Laparoscopy has become the method of excellence for abdominal surgeries in modern age. The significance of a secure and dependable approach for the initial trocar insertion cannot be overstated in this surgical procedure. Our preferred method involves employing a modified open technique to access the peritoneal cavity. This study was conducted to evaluate the laparoscopic surgery of modified open technique. This cross sectional follow-up study was conducted in the Department of General Surgery Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2019 to December 2022. The umbilicus was everted to make it tubular, an infra-umbilical incision was given to cut the linea alba for making an opening and advanced bluntly to introduce the first port. A total of 197 patients were studied after completion of surgery. Cholecystectomy was the most common surgical indication. The mean entry time was 3.1±0.6 minutes. Regarding the postoperative complication port site infection was 2.03% and port site hernia was 1%. There was no incidence of pre-peritoneal placement of port, port site seroma, haematoma. No mortality was found during the hospital stay of patients. Modified open technique is a quick and safe procedure for insertion of the first port in laparoscopic surgery. Bangladesh Med J. 2023 May; 52(2): 11-14
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Dama, R., P. Rebala, and G. Rao. "Laparoscopic completion cholecystectomy is generally feasable, safe and allays the symptoms in post cholecystectomy patients with gallbladder and cystic duct remnants." HPB 20 (September 2018): S745. http://dx.doi.org/10.1016/j.hpb.2018.06.1519.
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Yılmaz, Nezir, and Yunus Bozok. "Awake laparoscopic cholecystectomy under thoracal segmental spinal anesthesia and intermediate cervical plexus block: A case series." Challenge Journal of Perioperative Medicine 3, no. 2 (2025): 58. https://doi.org/10.20528/cjpm.2025.02.005.
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Laparoscopic cholecystectomy (LC) is the preferred approach for treating gallstone disease because of its minimally invasive characteristics. However, factors such as increased intra-abdominal pressure, pneumoperitoneum, and positional changes present significant challenges in anesthetic management. While LC is typically performed under general anesthesia, thoracic segmental spinal anesthesia and cervical plexus block have emerged as effective alternatives in patients for whom general anesthesia poses a high risk. This study reports the use of thoracic spinal anesthesia combined with cervical plexus block in patients where general anesthesia is considered risky. After obtaining informed consent for awake laparoscopic surgery, anesthesia was managed under appropriate monitoring. The combination of spinal anesthesia and cervical plexus block allowed for the successful completion of the procedure, with minimal complications observed in the early postoperative period. In conclusion, thoracic segmental spinal anesthesia and intermediate cervical plexus block offer a safe and effective alternative for patients at high risk for general anesthesia.
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Kumbhare, Nivedika, Anuj Dubey, Chandra Sekhar Mishra, Vinay Yadav, and Nupur Chakravarty. "To Compare Isobaric Thoracic Spinal Anesthesia Versus General Anesthesia in Laparascopy Cholecystectomy." Indian Journal of Anesthesia and Analgesia 10, no. 1 (2023): 15–20. http://dx.doi.org/10.21088/ijaa.2349.8471.10123.2.
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Background: The laparoscopic cholecystectomy procedure is typically carried out under general anesthesia, but regional techniques, such as low thoracic isobaric spinal anesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anesthesia. Segmental spinal anesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. Material and Methods: Total 60 adult patient with ASA1 & I I, 18-60 years, with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric) - given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9-T10/T10-T11 into sub arachnoid space. Group GA – given general anesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methylsulfate and glycopyrrolate at the end of surgery. Results: Isobaric spinal anesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itchng which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. Conclusions: In conclusion, this study provide evidence that segmental spinal anesthesia can be used in place of general anesthesia in healthy individuals also.
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Anubhav, Arya, Varshney Privy, Balyan Hardeep, and Siva Sai Akshay Mitnala. "Comparative Study of Conservative Management, Ultrasound Guided Needle Aspiration and Ultrasound Guided Pigtail Drainage of Uncomplicated Amoebic Liver Abscess." International Journal of Current Pharmaceutical Review and Research 15, no. 06 (2023): 431–41. https://doi.org/10.5281/zenodo.12606463.
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AbstractBackground: Ultrasound guided aspiration and pigtail catheter insertion in ultrasonographic guidance are safeprocedures without any major or life threatening complications. This study was conducted in The Department ofGeneral Surgery and Radiodiagnosis in Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, on patients whowere admitted from casualty and outpatient department with a diagnosis of amoebic liver abscess (ALA).Methods: A total of 60 patients were identified as the study group for the purpose of thesis. The mean durationof symptoms at presentation in Study Group I was 15.710.77, in Group II was 14.110.34 and in Group III was16.49.37. VAS was measured at completion of 48 hours of therapy allotted to each group. The change in TLC inthese patients was statistically significant (p=0.00).Results: In Group I (16/20) patients, the mean hospital stay was 5.750.68 and 4.470.72 days, respectively. GroupII (17/20) cases showed no improvement in VAS. Group III (20/20): The mean TLC was 84401522.947cells/mm3. In Group II (20/20), 4 nonresponders (20 %) of Group I, were shifted to Group II and 3 non-responders(15 %) from Group II, were moved to Group III due to persistent pain & fever and no improvement of TLC &abscess size.Conclusion: Our study shows marked and rapid clinical, biochemical and radiological improvement in patientsof ALA treated with USG guided indwelling catheter drainage along with medical treatment particularly in largeabses or abcess containing thick pus
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Ravi Kaushik, Rajesh Kumar, Narendra Singh Bafila, Rachna Verma, and Sanni Deyol Gautam. "A comparative study to access the impact of TAP block with wound infiltration in laparoscopic cholecystectomy." Asian Journal of Medical Sciences 15, no. 10 (2024): 34–39. https://doi.org/10.71152/ajms.v15i10.4214.
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Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure. Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P<0.001). Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia.
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Kaushik, Ravi, Rajesh Kumar, Narendra Singh Bafila, Rachna Verma, and Sanni Deyol Gautam. "A comparative study to access the impact of TAP block with wound infiltration in laparoscopic cholecystectomy." Asian Journal of Medical Sciences 15, no. 10 (2024): 34–39. http://dx.doi.org/10.3126/ajms.v15i10.67635.
Full textAbstract:
Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure. Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P<0.001). Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia.
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Joshi, H. N., A. K. Singh, D. Shrestha, I. Shrestha, and R. M. Karmacharya. "Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal." Kathmandu University Medical Journal 18, no. 3 (2020): 256–59. http://dx.doi.org/10.3126/kumj.v18i3.49219.
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Background Gallstone disease is one of the most common surgical problem throughout the world. The rise in gallstone disease burden and its wide spectrum of non-specific presentation makes the disease more challenging.
 Objective To know the various modes of presentation, socio-demographic details of the patients with gallstone disease, any associated factors and its treatment options.
 Method This is a prospective descriptive study in the patients presenting to Dhulikhel Hospital Kathmandu University Hospital diagnosed with gallstone during May 2018 to April 2020. After receiving ethical clearance from institutional Review committee, the informed consent was taken from all patient involved in the study. The presence of gallstone was confirmed by abdominal ultrasonography (USG). This study included total of 202 patients with gallstone disease.
 Result A total of 202 individuals with gallstone were included in the study; 48 males (24%) and 154 females (76%). The disease condition was common in age group 31-40 years (26.24%). Majority of the study population consumed mixed diet (92.57%). Out of 202 patients; 52 patients (25.74%) were overweight. In this study series 185 patients (91.58%) were symptomatic. Pain abdomen was one of the commonest symptoms (97.84%) followed by Nausea (28.11%), Dyspepsia (28.11%), Vomiting (18.38%), Fever (1.62) and Jaundice (1.08%). All cases were planned for laparoscopic cholecystectomy however 4 cases had to be converted to open surgery for completion.
 Conclusion Gallstone disease is a common surgical problem in Female population that presents most commonly with pain abdomen. Laparoscopic cholecystectomy can be easily performed in all cases of gallstone disease.
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Desai, Gunjan, Prasad Pande, Rajvilas Narkhede, and Prasad Wagle. "Laparoscopic completion cholecystectomy for late postcholecystectomy Mirizzi syndrome Csendes type 1 due to a sessile gallbladder remnant calculus." HPB 21 (2019): S470. http://dx.doi.org/10.1016/j.hpb.2019.10.2282.
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Song, Ruijin, Li Feng, Xueyi Liu, Bo Yang, Ming Gong, and Tie Qiao. "Laparoscopic and Seldinger techniques for the treatment of concomitant gallstones and choledocholithiasis. A retrospective study." Investigación Clínica 64, no. 2 (2023): 165–72. http://dx.doi.org/10.54817/ic.v64n2a03.
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Abstract. This study aimed to determine the efficacy and safety of a mini-mally invasive combined approach for concomitant stone clearance of choleli-thiasis and choledocholithiasis. FromNovember 2018 to March 2021, 30 pa-tients were enrolled in this retrospective study that compared two methods of treating combined cholelithiasis and choledocholithiasis. The study comprised two groups: 15 patients in Group A underwent combined laparoscopic and Seldinger techniques for complete stone clearance, retaining the gall bladder in situ. In Group B, 15 patients underwent laparoscopic cholecystectomy and choledocholithotomy with T-tube drainage. The rates of successful completion of the operations, procedure-related complications, length of hospitalization, hospital cost, and patient satisfaction were compared between the two groups. The two groups had no differences in general patient characteristics, and all procedures were successfully completed. Compared to Group B, patients in Group A had a shorter operative time (84 vs. 105 min), less blood loss (10 vs. 28 mL), were less expensive, and had a shorter postoperative recovery. A single patient in group B developed bile leakage. The satisfaction rate was 93% in Group A, in contrast to 80% in Group B. The combined use of laparoscopic and Seldinger techniques to achieve complete stone removal in patients with con-comitant cholelithiasis and choledocholithiasis was demonstrated to be safe and successful.
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Aqsa, Tariq Anam Pervez Mishal Khan. "THE GYNECOLOGICAL LAPAROSCOPIC SURGERIES, ABOUT FACTORS, METHODS ADOPTION, FACING DIFFICULTIES FOR THE RELATED DIMINUTION FOR PATIENT'S PAIN AFTER OPERATION: DESCRIPTIVE RESEARCH STUDY." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES 05, no. 10 (2018): 10639–46. https://doi.org/10.5281/zenodo.1470029.
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<strong><em>Aims:</em></strong><em> The purpose of this research paper was to share the knowledge related to the gynecological laparoscopic surgeries in the Services Hospital, Lahore.</em> <em>Study Design: Descriptive research study.</em> <strong><em>Place and Duration:</em></strong><em> Carried out Present detailed study with effect from February 2017 to April, 2018 in gynecological laparoscopic department of the Services Hospital, Lahore.</em> <strong><em>Methods:</em></strong><em> All of us made a detailed study with effect from February 2017 to April, 2018 for the patient’s analyzation. We have examined the 218 peoples, out of those mostly of them were between the age of twenty-seven to thirty years old (25%). The cases of ectopic pregnancy had the number of 28 (13%) and the cases of Ovarian Cyst had the number of 111 (52%). The patients faced the gynecological laparoscopic surgeries their factors, difficulties and types of procedures.</em> <strong><em>Results:</em></strong><em> Examined total of 218 patients carefully selected for the study. The cases of ectopic pregnancy had the number of 28 (13%) and the cases of Ovarian Cyst had the number of 111 (52%). There had 8 patients, ovarian cystectomy or hysterectomy and cholecystectomy surgeons treated them. There were 32 patients of laparoscopy, we diagnosed. Laparoscopic hysterectomy had checked in 33 patients. Laparotomy exchange took place in 8 patients and only one patient had the vascular problems. There had the ordinary and constant complaints of pain in different degrees of post-operation. These complaints over came through parenteral and oral analgesics. Oral medication via its way adopted with effect from fourth / sixth hours and after completion of a day progress had begun. 164 cases admitted in hospital and medicated for two days (75%) and rest of the 53 patients (25%) got medication for more than two days and longer period</em> <strong><em>Conclusion:</em></strong><em> Laparoscopic surgery may control post -operative ache according to the examination of patients. This as well minimized the size of scream on post-operation and also taught that medication and admission is compulsory at medical Centre for the entire and instant improvement. Hence satisfactory expertise and proficient teaching staff is compulsory for Victorious and accomplished laparoscopic operations.</em> <strong>Keywords:</strong><em> Gynecological Laparoscopic Surgeries (GLS) and Hysterectomy. Cystectomy</em>