Is laparoscopic cholecystectomy a mature operative technique?
BACKGROUND
More than 10 years after its introduction, laparoscopic cholecystectomy has become the method of choice for the treatment of cholecystolithiasis. However intraoperative difficulties with dramatic postoperative consequences have been reported. The aim of this study was to identify what role the two-dimensional view, the surgeon's experience, the instruments, technical tools and their (time) influence exercised on the operation course in daily laparoscopic operations.


METHODS
The operative times for 30 laparoscopic cholecystectomies were investigated by ergonomic sequence analysis and analyzed statistically with the use of the Wilcoxon test.


RESULTS
Comparing experienced and less experienced surgeons, a significant difference in the duration of the operation was observed (56 +/- 24 min compared to 75 +/- 13 min p = 0,025), especially in the laparoscopic intra-abdominal phase of the operation. The prolonged duration of the operation (15-20%) was mainly due to problems with the technical tools (40%) and the use of instruments (23.5%). Visualization had a minor influence (14.4%) on the duration of the operation, and the negative effect of the two-dimensional view (0.5%) was negligible. The last two factors did not cause any complications.


CONCLUSIONS
The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon's experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon's demands for a safe procedure.
Welty
G
G
Department of Surgery, University Hospital RWTH Aachen, Pauwelslrasse 30, D-52072 Aachen, Germany. georg.welty@post.rwth-aachen.de
Schippers
E
E
Grablowitz
V
V
Lawong
A G
AG
Tittel
A
A
Schumpelick
V
V
D000208:Acute Disease; D002245:Carbon Dioxide; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D002764:Cholecystitis / Q000601:surgery; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D007327:Insufflation; D007431:Intraoperative Complications / Q000209:etiology; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D020535:Video-Assisted Surgery / Q000379:methods
D002245:Carbon Dioxide