Mini-laparotomy cholecystectomy: Technique, outcomes: A prospective study

AbstractBackgroundThe last decades have been characterized by a rapid growth in minimally invasive techniques for acute and chronic cholecystitis. The aim of our study was to analyze 10years of experience with the mini-laparotomy cholecystectomy.MethodsFrom 1994 to 2004, we performed 2295 mini-laparotomy cholecystectomies, including 1028 patients with acute and 1267 patients with chronic cholecystitis. There were 1780 women and 515 men. We utilized a special surgical tool kit with a system of circular and small hook-retractors incorporating an illuminator and long surgical instruments. Our surgical approach was carried out using a 3–5cm longitudinal incision located immediately above the gallbladder with a muscle splitting technique.ResultsThe mean time of operation was 64.5±24.5min and the conversion rate was 3.7%. Intraoperative complications occurred in 25 cases (1.1%), including 4 cases (0.17%) of biliary tract injury. Cholecystectomy was combined with intervention on the choledochus and the papilla of Vater in 133 patients with choledocholithiasis. Postoperative complications developed in 4.1%. Five hundred and five patients (22%) required opioid analgesics on the first postoperative day. The mortality rate was 0.17%. The mortalities involved patients who had severe concomitant diseases and required urgent surgery for acute cholecystitis. Patients operated for acute cholecystitis had significantly higher rates of postoperative complications (5.8% vs. 2.8%), need for opioids (25.5% vs. 19.2%) and mortality (0.39% vs. 0%).ConclusionsMini-laparotomy cholecystectomy is an alternative to laparoscopic approach in the surgical treatment of acute and chronic cholecystitis

Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a multicenter propensity score-matched study

Background: The role of laparoscopy in the treatment of intrahepatic cholangiocarcinoma (ICC) remains unclear. This multicenter study examined the outcomes of laparoscopic liver resection for ICC. Methods: Patients with ICC who had undergone laparoscopic or open liver resection between 2012 and 2019 at four European expert centers were included in the study. Laparoscopic and open approaches were compared in terms of surgical and oncological outcomes. Propensity score matching was used for minimizing treatment selection bias and adjusting for confounders (age, ASA grade, tumor size, location, number of tumors and underlying liver disease). Results: Of 136 patients, 50 (36.7%) underwent laparoscopic resection, whereas 86 (63.3%) had open surgery. Median tumor size was larger (73.6 vs 55.1 mm, p¼ 0.01) and the incidence of bi-lobar tumors was higher (36.6 vs 6%, p< 0.01) in patients undergoing open surgery. After propensity score matching baseline characteristics were comparable although open surgery was associated with a larger fraction of major liver resections (74 vs 38%, p< 0.01), lymphadenectomy (60 vs 20%, p< 0.01) and longer operative time (294 vs 209 min, p< 0.01). Tumor characteristics were similar. Laparoscopic resection resulted in less complications (30 vs 52%, p¼ 0.025), fewer reoperations (4 vs 16%, p¼ 0.046) and shorter hospital stay (5 vs 8 days, p< 0.01). No differences were found in terms of recurrence, recurrence-free and overall survival. Conclusion: Laparoscopic resection seems to be associated with improved short-term and with similar long-term outcomes compared with open surgery in patients with ICC. However, possible selection criteria for laparoscopic surgery are yet to be defined

New Minimally Invasive Techniques in the Treatment of Patients with Lesions in the Liver: Laparoscopy and Extracorporeal High Intensity Focused Ultrasound

Laparoscopic liver resection has shown classical advantages of minimally invasive surgery over the open counterpart. In spite of introduction in early 1990-s only few centres worldwide adapted laparoscopic liver resection to routine practice. It was due to considerable technical challenges and uncertainty about oncologic outcomes. Various ablative techniques have been developed last 2 decades in parallel with laparoscopy. High intensity focused ultrasound (HIFU) attracts special interests due to its fully non-invasive nature. The main goal of this thesis was to estimate and develop new minimally invasive techniques in the treatment of patients with lesions in the liver: laparoscopic surgery and HIFU. Two hundred and twenty patients, who underwent laparoscopic liver resection during 244 procedures from August 1998 to December 2010 at the Oslo University Hospital, Rikshospitalet, formed the research basis for the clinical section of this thesis. An experimental porcine model was applied to study HIFU. The study revealed lower complication rate and shorter postoperative hospital stay after laparoscopic procedures compared with rates typical for conventional open surgery. However, favourite oncologic outcomes after laparoscopic liver resection, 51% of 5-year overall survival and 42% of 5-ear disease-free survival, were most important outcome of this thesis. The dissertation also proved both feasibility and efficiency of repeat liver resection. Effective technical solutions in regard to so-called difficult posterosuperior segments represented another secondary point of this thesis. The experimental section of the dissertation defined challenging points of HIFU techniques in regard to liver lesions and suggested efficient solutions to overcome them