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

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

Laparoscopic and open surgery for pheochromocytoma

Backround Laparoscopic adrenalectomy is a promising alternative to open surgery although concerns exist in regard to laparoscopic treatment of pheocromocytoma. This report compares the outcome of laparoscopic and conventional (open) resection for pheocromocytoma particular in regard to intraoperative hemodynamic stability and postoperative patient comfort. Methods Seven patients laparoscopically treated (1997–2000) and nine patients treated by open resection (1990–1996) at the National Hospital (Rikshospitalet), Oslo. Peroperative hemodynamic stability including need of vasoactive drugs was studied. Postoperative analgesic medication, complications and hospital stay were recorded. Results No laparoscopic resections were converted to open procedure. Patients laparoscopically treated had fewer hypertensive episodes (median 1 vs. 2) and less need of vasoactive drugs peroperatively than patients conventionally operated. There was no difference in operative time between the two groups (median 110 min vs. 125 min for adrenal pheochromocytoma and 235 vs. 210 min for paraganglioma). Postoperative need of analgesic medication (1 vs. 9 patients) and hospital stay (median 3 vs. 6 days) were significantly reduced in patients laparoscopically operated compared to patients treated by the open technique. Conclusion Surgery for pheochromocytoma can be performed laparoscopically with a safety comparable to open resection. However, improved hemodynamic stability peroperatively and less need of postoperative analgesics favour the laparoscopic approach. In experienced hands the laparoscopic technique is concluded to be the method of choice also for pheocromocytoma. © Edwin et al 2001 This article is published under license to BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL