Ten-point Strategy for Safe Laparoscopic Cholecystectomy: A Prospective Study
World Journal of Laparoscopic Surgery with DVD
Aims/objectives: To devise a 10-point strategy for performing safe laparoscopic cholecystectomy (LC), share experience of 8,000 patients without any conversion to open procedure by adopting the strategy, and assess its effectiveness. Materials and methods: A total of 8,000 patients were prospectively analyzed during 2007 to 2017. A point was assigned to a specific finding intraoperatively. Patients were divided into three groups based on the points. Anatomical variations, time of surgery,
... perative/postoperative complications were plotted for three groups, and statistical significance was calculated. Results: In this study, 63.5% of patients were female. No case of conversion to open cholecystectomy (OC) was found. The youngest and oldest patients were 2 and 109 years old, respectively. Mortality, negligible morbidity, or significant complications were not observed. Group I (1-4 points) had high-risk patients, and lowest safety, and group III (8-10 points) had low-risk patients, and highest safety, and group II (5-7 points) had with equivocal numbers. Conclusion: Laparoscopic cholecystectomy was performed keeping these 10 points in mind with patience and precautions. Chances of conversion to open surgery can be reduced to zero, with minimal complications. The study suggests that in case of difficult anatomy, go gentle and slow to safeguard from injuries. IntroductIon Gallbladder (GB) diseases are few of the commonest biliary tract diseases 1,2 and surgical conditions requiring intervention worldwide. 3,4 Laparoscopic cholecystectomy (LC) was introduced nearly 3 decades ago, and since then, it has become the gold standard; 5,6 nearly 90% cholecystectomies are laparoscopically performed. 7,8 Patient-or surgeon-related multiple factors can lead to various complications and conversion to open cholecystectomy (OC). 4,9,10 An OC is often performed for patients with GB mass or suspicion of GB malignancy, late third trimester of pregnancy, previous upper abdominal surgeries, >60 years of age, male sex, diabetes, history of endoscopic retrograde cholangiopancreatography, dilated common bile duct (CBD), and GB status; it is also performed when the laparoscopic approach fails. 7, 11, 12 Despite the experience, complication rates are higher with LC than OC, but those with OC are increasing due to decreased exposer to open procedure. 7, 8, 13, 14 During laparoscopic procedure, complication rates can be reduced with proper care and caution. 11,15 As a surgeon's experience increases, complication and conversion rates decrease. 11, 16 This study aimed to share the experience of surgeons while performing safe LC and points to consider in order to decrease complication and conversion rates.