Grasper trauma during laparoscopic cholecystectomy.
BACKGROUND
The present study characterized the histopathological nature of laparoscopic grasper trauma during laparoscopic cholecystectomy in a prospective, blinded trial in order to establish a model for laparoscopic grasper trauma. The null hypothesis that graspers cause no histologically distinct tissue injury was tested.


METHODS
The gall bladders of 19 patients undergoing laparoscopic cholecystectomy were examined. The area of gall bladder that had been grasped by Debakey laparoscopic forceps was excised (sample), along with an area of gall bladder that had not been grasped (control). Paired specimens were examined by a pathologist (blinded) to identify which was 'sample' and which was 'control' and to assess for histological markers of crushed tissue injury. The data were analysed by chi-squared or Fisher's exact tests.


RESULTS
The pathologist was able to identify the sample (gripped) specimen in 13 of the 19 cases. In the remaining six cases the pathologist was unable to determine the specimen that had been gripped due to either absence of damage (four cases), or severe inflammation precluding assessment (two cases). The ability of the pathologist to distinguish the sample from the control specimen was significant (chi-squared test, P = 0.003). Of the histological markers of crushed tissue injury, focal thinning of the gall bladder wall and epithelial loss were present in significantly more sample (gripped) specimens than control specimens (chi-squared test, P = 0.0002 and P < 0.0001, respectively).


CONCLUSIONS
Laparoscopic graspers cause tissue trauma that can be assessed histologically. The current study presents a relevant, reproducible, ethically acceptable human model for assessing the interaction between laparoscopic graspers and soft tissues.
Marucci
D D
DD
Department of Surgery, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
Shakeshaft
A J
AJ
Cartmill
J A
JA
Cox
M R
MR
Adams
S G
SG
Martin
C J
CJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D005704:Gallbladder / Q000293:injuries*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000473:pathology*; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D013525:Surgical Instruments / Q000009:adverse effects*; D013997:Time Factors