[Videolaparoscopic cholecystectomy. Experience, evolution, and comparison of techniques].
The paper broadly outlines the technique of laparoscopic cholecystectomy used by the authors to treat patients suffering from calculosis of the gallbladder. Basing their comments on the French school, the authors review the literature to identify those innovations introduced by individual operators in elation to the original technique which have enabled this method to be extended to those cases complicated by acute cholecystitis, VBP calculosis or sequelae from abdominal surgery. The most important innovations include the use of a laparoscope with oblique 30-degrees vision, which is extremely useful during the dissection of Calot's triangle since it allows VBP to be identified with greater ease and precision, above all in the event of phlogistic sequelae enclosing the peduncle. In addition, laparoscopic suture or ligation using Roeder's running-knot, used by the Dundee school to treat the cystic duct and artery, presents considerable advantages compared to the conventional use of metal clips. The authors also emphasise the growing return to intraoperative cholangiography which is routinely performed by some authors and is of value in identifying anatomic anomalies, iatrogenic lesions and VBP calculi unnoticed by preoperative tests. A second innovation which is highlighted consists of the treatment of choledocholithiasis during the course of laparoscopic cholecystectomy, in addition to pre- and postoperative endoscopic papillo-sphincterotomy.
Casciola
L
L
ULSS del Comprensorio Spoletino, Servizio di Pronto Soccorso e Astanteria, Ospedale di Spoleto Perugia.
Costa
A M
AM
Bececco
D
D
De Matteis
F
F
Squeo
S
S
Proietti Silvestri
G
G
Calabresi
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
Colecistectomia videolaparoscopica. Esperienza, evoluzione e tecniche a confronto.