title: From inside out. Microperforation of the gallbladder during laparoscopic surgery may liberate mucosal cells.
abstract: BACKGROUND
  Port-side recurrence after laparoscopic surgery on known and unsuspected gastrointestinal malignancies has been reported. The mechanisms of this type of metastatic spread are poorly understood. For in situ malignancies, microperforation of the viscus by laparoscopic instruments may liberate cells to facilitate malignant cell movement.
  
  
  METHODS
  Twenty-three patients undergoing laparoscopic cholecystectomy for benign disease were prospectively studied. The laparoscopic fundal grasper was washed with sterile saline at the start and conclusion of surgery. These washings were examined for the presence of mucosal cells as evidence that gallbladder perforation occurred during the operation.
  
  
  RESULTS
  No mucosal cells were seen from washings at the start of surgery. Thirteen cases (56%) of perforation or attempted choledochogram were recorded during surgery. Four of these 13 washings contained mucosal cells. One washing was positive for mucosal cells in the absence of perforation or attempted choledochogram.
  
  
  CONCLUSIONS
  Microperforation of the gallbladder by laparoscopic instruments occurs during laparoscopic cholecystectomy.
authors.affiliation: Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville South, South Australia, Australia, 5011.
authors.forename: M L
authors.initials: ML
authors.lastname: Texler
authors.forename: G
authors.initials: G
authors.lastname: King
authors.forename: P J
authors.initials: PJ
authors.lastname: Hewett
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005704:Gallbladder / Q000166:cytology; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D009092:Mucous Membrane; D011446:Prospective Studies