Mini-lap cholecystectomy: modifications and innovations in technique.
BACKGROUND
As with any technology-driven field, laparoscopic surgery has made tremendous progress in recent years. Since the performance of first laparoscopic cholecystectomy by Prof Dr Med Erich Mühe of Böblingen, Germany 1985, this procedure has overtaken open cholecystectomy as the treatment of choice in cholelithiasis. However due to the cost incurred thereof and surgical training needed, open cholecystectomy is still performed on a very large scale in most parts of the third world countries. We tried to modify the conventional cholecystectomy to a minimal access approach (with minimal required infrastructure) to suit majority of patients with cholelithiasis in lieu of cost and morbidity.


OBJECTIVE
To assess the outcome of modified mini-lap cholecystectomy and report our experience with our innovations and modifications of the technique.


METHODS
Between May 2006 and May 2008, two hundred patients with cholelithiasis aged between 15 and 56 years underwent mini-lap cholecystectomy in a prospective study in Government medical college Srinagar. Our surgical approach was carried out using a 3-5cm oblique incision located two finger breadths below the costal margin; fashioned more laterally with a muscle cutting or splitting technique. The outcome was assessed in terms of intraoperative and postoperative parameters. The median (range) age was 38 (15-56) years and there were 143 females and 57 males in the study. All the procedures were completed successfully without any complications, though one patient needed the extension of incision as in conventional cholecystectomy.


RESULTS
All the procedures were completed successfully. The mean (range) operative time was 35 (20-110)min and the average blood loss was 30ml. The mean (range) hospital stay was 2 (1-5) days. All patients returned back to routine work within 9 days of surgery. The mean follow-up was 12 (7-14) months.


CONCLUSIONS
These results confirm that mini-lap cholecystectomy by our modified approach is safe, feasible and has lesser morbidity and postoperative pain as compared to conventional open cholecystectomy. The technique is cost effective, easy to practice and can benefit majority of patients who otherwise cannot afford the laparoscopic surgery. Hence it can serve as an alternative to the gold standard laparoscopic cholecystectomy with almost comparable results.
Chalkoo
Mushtaq
M
SMHS Hospital and its associated Government medical college, Srinagar, Kashmir, Jammu and Kashmir, India. mushtaq_chalkoo@rediffmail.com
Ahangar
Shahnawaz
S
Durrani
Abdul Munnon
AM
Chalkoo
Shaheena
S
Shah
Masooda Jan
MJ
Bashir
Muhammad Idrees
MI
D000293:Adolescent; D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult