Agarwal B B, Gupta Manish, Agarwal Sneh, Mahajan Krishan
Department of General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India.
Surg Endosc. 2007 Dec;21(12):2154-8. doi: 10.1007/s00464-007-9320-y. Epub 2007 May 4.
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.
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.
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 regular outpatient visits until they were well.
A safe laparoscopic cholecystectomy without using any energy source can be performed by following the proper anatomical footprint.
在过去二十年中，腹腔镜胆囊切除术已成为治疗胆囊结石的金标准，也是评估腹腔镜手术技能的标志性手术。其应用范围的扩大和技术的不断完善，并未伴随着因胆道、血管或内脏损伤导致的发病率相应降低。使用能量源，尤其是单极电外科设备，已被确定为许多此类损伤的罪魁祸首。本研究通过利用无血管解剖平面，评估了不使用任何能量源安全实施腹腔镜胆囊切除术的可行性。
纳入在本中心手术门诊就诊、符合腹腔镜胆囊切除术条件的患者。术前获得每位患者的知情同意。本研究经医院伦理审查委员会批准，并按照GCP指南进行。
2005年6月至2006年7月，共纳入83例患者。所有患者均在未使用任何能量源的情况下接受了腹腔镜胆囊切除术。未发生胆道、血管或内脏损伤。所有患者血流动力学均保持稳定。无中转手术或死亡病例。住院时间为8 - 16小时。患者在术后48小时内接受电话随访，之后定期门诊随访直至康复。
遵循正确的解剖路径，不使用任何能量源即可安全实施腹腔镜胆囊切除术。
