title: Safety and efficacy of laparoscopic cholecystectomy using monopolar electrocautery in the porcine model.
abstract: Recent reports suggest that laparoscopic laser cholecystectomy may become the preferred therapy for symptomatic cholelithiasis. To assess the efficacy and safety of this technique, using monopolar electrocautery instead of laser for the gallbladder dissection, laparoscopic cholecystectomy was performed on 11 pigs. Under general anesthesia, a pneumoperitoneum was established, and four sheaths were placed into the abdomen for introduction of instruments. Using video laparoscopic guidance, the cystic duct and artery were isolated, clipped, and divided. Monopolar electrocautery was used to dissect the gallbladder from its fossa. Five animals were sacrificed immediately, without visible evidence of injury to the bile ducts, liver, or intestine. The remaining six pigs were allowed to recover. One animal died 10 days postoperatively due to adhesive small bowel obstruction. The remainder survived in good health until sacrifice at 1 month. Histologic examination of the gallbladder bed and liver revealed no evidence of ongoing local hepatocyte destruction or chronic cholestasis. Cholangiography demonstrated the bile ducts to be intact. Mean (+/- SEM) total serum bilirubin (TB), alkaline phosphatase (AP), and glutamic oxalacetic transaminase (SGOT) at the time of sacrifice were similar to nonoperated swine (n = 10): TB, 0.12 +/- 0.02 versus 0.11 +/- 0.01 mg/dl; AP, 175 +/- 23 versus 162 +/- 10 IU/L; SGOT, 37 +/- 4 versus 55 +/- 7 IU/L, respectively (p > 0.05). We conclude that laparoscopic cholecystectomy can be performed using monopolar electrocautery without significant acute injury to the liver, bile ducts, or surrounding viscera. Furthermore, the porcine model can be utilized by surgeons to attain competence in this technique prior to instituting clinical application in humans.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: N J
authors.initials: NJ
authors.lastname: Soper
authors.forename: J A
authors.initials: JA
authors.lastname: Barteau
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
authors.forename: M J
authors.initials: MJ
authors.lastname: Becich
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D000818:Animals; D001158:Arteries / Q000601:surgery; D001219:Aspartate Aminotransferases / Q000097:blood; D001652:Bile Ducts / Q000473:pathology; D001663:Bilirubin / Q000097:blood; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods; D003549:Cystic Duct / Q000601:surgery; D004210:Dissection; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods; D005260:Female; D005549:Foreign-Body Reaction / Q000473:pathology; D005704:Gallbladder / Q000098:blood supply; D007422:Intestines / Q000473:pathology; D008099:Liver / Q000201:enzymology / Q000473:pathology; D011028:Pneumoperitoneum, Artificial; D012449:Safety; D013552:Swine; D000267:Tissue Adhesions / Q000473:pathology
chemical_list: D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin