Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Videos demonstrating this technique are available online.
J Laparoendosc Adv Surg Tech A. 2021 Apr;31(4):390-394. doi: 10.1089/lap.2020.1001. Epub 2021 Jan 20.
The contracted gallbladder may predispose to a higher rate of biliary or vasculobiliary injury (VBI). It is usually associated with unclear anatomy due to chronic inflammation and fibrosis in the hepatoduodenal ligament region. Laparoscopic ultrasound (LUS) can very effectively delineate anatomical conditions during cholecystectomy. Our study aimed to compare the visual and ultrasonographic navigation around the shrunken gallbladder. The study group consisted of 612 patients qualified for laparoscopic cholecystectomy. The shrunken gallbladder was diagnosed intraoperatively in 13 patients (2.1%). In 6 patients, the only intraoperative navigation method was a visual evaluation of anatomical conditions, and in 7 patients, the method was LUS. The operating time and the length of hospital stay after surgery were significantly lower, the number of conversions was insignificantly lower, and the number of successful visualization of anatomical conditions was significantly higher in the LUS group. We did not observe any bile duct and VBI in patients with the shrunken gallbladder. The combination of the fundus-first and subtotal cholecystectomy with LUS navigation might be an effective proposal when coming across the shrunken gallbladder.
萎缩的胆囊可能更容易发生胆道或血管胆道损伤 (VBI)。由于肝十二指肠韧带区域的慢性炎症和纤维化，其解剖结构通常不清晰。腹腔镜超声 (LUS) 可以在胆囊切除术中非常有效地描绘解剖结构。我们的研究旨在比较萎缩胆囊周围的视觉和超声导航。研究组包括 612 名符合腹腔镜胆囊切除术条件的患者。术中诊断出 13 例（2.1%）萎缩性胆囊。6 例患者仅采用视觉评估解剖结构的术中导航方法，7 例患者采用 LUS 方法。LUS 组的手术时间和术后住院时间明显缩短，中转率无显著降低，解剖结构的可视化成功率明显更高。我们在患有萎缩性胆囊的患者中未观察到任何胆管和 VBI。在遇到萎缩性胆囊时，采用底部优先和次全胆囊切除术联合 LUS 导航可能是一种有效的方法。
