[Biliary complications during videolaparoscopic cholecystectomy. Remarks on methodology and indications in the training period].
In our study we have considered the activity of a surgeon working in our Surgery Department during his laparoscopic training period. We focus our attention on a date related to the same complications checked in 27 cases of cholelithiasis operated by the same surgeon. We have observed three cases of biliary cholelithiasis fistulas, all of them during the three last operations. The examination of the above mentioned cases considers the clinical post-surgery situation and the therapeutic standards we adopted to work out the complications. Now we can precisely state, according to our experience, the particular directions for the videolaparoscopic training period. In addition we can propose one simple mathematical formula to value the IRL (Laparoscopic Risk Index) concerning three variables: the experience of the surgeon; the instruments  condition; the clinical situation of the patient. The relation of these three factors turned in numbers suggests the chance of success of a videolaparoscopic operation. We conclude our study mentioning the gasless videolaparoscopic technique that seems to have a large indication, according to the same Surgery School. This technique is particulary indicated on those classes of patients in which the CO2 insufflation into abdominal cavity and the increase of endocavity pressure can represent a contraindication to the videolaparoscopic approach: in this case the surgeon will follow the surgical indication to solve the clinical situation, as happens in war surgery.
Cattedra di Chirurgia d Urgenza, Divisione di Chirurgia Generale e Pronto Soccorso, Ospedale Clinicizzato San Donato, Università degli Studi, Pavia, Italy.
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Faccini
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Bonandrini
D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D020535:Video-Assisted Surgery / Q000009:adverse effects