[The development of laparoscopic technology in light of cholecystectomies performed between 1994 and 2007].
The spread of laparoscopy has required surgeons to familiarize with a completely new surgical method and by today this method has clearly become of major importance in gastrointestinal surgery. The evolution of laparoscopic cholecystectomy offers many good lessons to learn for the purposes of advanced laparoscopic surgeries and surgeons may benefit from this experience in any process of introducing new minimal invasive techniques.


METHODS
We have made a retrospective analysis of the data of the cholecystectomies made in the 1st. Department of Surgery, Semmelweis University, right after laparoscopy had become a widely spread, routine surgical method (1994) as well as 13 years later (2007). The data have been processed using the SPSS 16.0 application package. Significance levels have been established with the chi-square probe.


RESULTS
Within the analyzed timeframe we could clearly see a growing use of laparoscopic techniques (52.09% vs. 90.13%) with a growing number of cases (263/304), unchanged average age (approximately 53.5 years) and constant male/female ratio (75/25%). The BMI increased moderately (26.5 vs. 27.6), but the frequency of laparoscopic interventions on extremely obese patients grew (BMI: 25-30 37.93% vs. 44.39%, 30-35 13.79% vs. 20.6% 35-40 6.89% vs. 5.82% and 40 \lt; 0% vs. 1.34%) while the postoperative hospitalization decreased dramatically from 5.9 days to 2.3. In year 1994, patients spent on the average 2.9 days in hospital after a laparoscopic surgery, while in year 2007 nearly 25% of the patients left the hospital 1 day after surgery. The duration of a laparoscopic surgery decreased from 78 minutes to 53, and the occurrence of intraoperative bleeding, gall bladder perforation and gallstone spillage also decreased. The conversion ratio increased from 2.7% to 4.9%. In 3% of the laparoscopic cholecystectomies (10 patients) only 3 ports were used during surgery.


CONCLUSIONS
As surgeons have come to master the new technique, the previous relative and absolute pros and cons have been revised and at present 90% of cholecystectomies are made using laparoscopy. The data collected in the analysis of laparoscopic techniques can be used to research, learn and eventually introduce Natural Orifice Transluminal Endoscopic Surgery.
Lukovich
Péter
P
Semmelweis Egyetem, Altalános Orvostudományi Kar I. Sebészeti Klinika Budapest Ulloi út 78. 1082. lukovich66@freemail.hu
Vanca
Tímea
T
Gero
Dániel
D
Kupcsulik
Péter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies