University of Maryland - School of Medicine - R Adams Cowley Shock Trauma Center -Baltimore (MD) - United States.
Hospital São Luiz - Department of Surgery - São Paulo (SP) - Brazil.
Acta Cir Bras. 2024 Aug 5;39:e395224. doi: 10.1590/acb395224. eCollection 2024.
Laparoscopic cholecystectomy, introduced in 1985 by Prof. Dr. Erich Mühe, has become the gold standard for treating chronic symptomatic calculous cholecystopathy and acute cholecystitis, with an estimated 750,000 procedures performed annually in the United States of America. The risk of iatrogenic bile duct injury persists, ranging from 0.2 to 1.3%. Risk factors include male gender, obesity, acute cholecystitis, previous hepatobiliary surgery, and anatomical variations in Calot's triangle. Strategies to mitigate bile duct injury include the Critical View of Safety and fundus-first dissection, along with intraoperative cholangiography and alternative approaches like subtotal cholecystectomy.
This paper introduces the shoeshine technique, a maneuver designed to achieve atraumatic exposure of anatomical structures, local hemostatic control, and ease of infundibulum mobilization. This technique involves the use of a blunt dissection tool and gauze to create traction and enhance visibility in Calot's triangle, particularly beneficial in cases of severe inflammation. Steps include using the critical view of safety and Rouviere's sulcus line for orientation, followed by careful dissection and traction with gauze to maintain stability and reduce the risk of instrument slippage.
The technique, routinely used by the authors in over 2000 cases, has shown to enhance patient safety and reduce bile duct injury risks.
The shoeshine technique represents a simple and easy way to apply maneuver that can help surgeon during laparoscopic cholecystectomies exposing the hepatocystic area and promote blunt dissection.
1985 年，埃里希·穆赫（Erich Mühe）教授引入了腹腔镜胆囊切除术，该手术已成为治疗慢性有症状的结石性胆囊病和急性胆囊炎的金标准，在美国每年估计有 750,000 例手术。医源性胆管损伤的风险仍然存在，范围为 0.2%至 1.3%。危险因素包括男性、肥胖、急性胆囊炎、既往肝胆手术和 Calot 三角的解剖变异。减轻胆管损伤的策略包括安全关键视图和从底部开始的解剖，以及术中胆管造影术和替代方法，如次全胆囊切除术。
本文介绍了擦鞋技术，这是一种旨在实现无创伤暴露解剖结构、局部止血控制和容易移动胆囊管的操作。该技术涉及使用钝性分离工具和纱布来创建牵引并增强 Calot 三角的可见度，特别是在严重炎症的情况下。步骤包括使用安全关键视图和 Rouviere 的沟线进行定位，然后小心地进行解剖和纱布牵引，以保持稳定性并降低器械滑脱的风险。
作者在超过 2000 例病例中常规使用该技术，结果表明该技术提高了患者的安全性并降低了胆管损伤的风险。
擦鞋技术是一种简单易用的操作方法，可以帮助外科医生在腹腔镜胆囊切除术中暴露肝胆囊区域并促进钝性分离。
