title: Can we pursue minimal invasive surgery in the setting of converted laparoscopic cholecystectomy? Consideration about the "MIVAC" approach.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic gallstones disease. Despite surgeon's expertise and laparoscopic technical skills, at times conversion to open laparotomy is still required to carry out safely the surgical procedure. In such cases, we still pursue a minimally invasive approach based on a very short subcostal laparotomy supported by laparoscopic magnification of the reduced surgical field. We named the procedure Minimally Invasive Video-Assisted Cholecystectomy (MIVAC). In the setting of a truly minimal laparotomy, the implementation of a laparoscope makes the difference in terms of improving observation respect to naked eye, providing both details' magnification and deep field illumination.
  
  
  METHODS
  Between 2003 and 2010, 1054 LC were performed at a single institution. Seventy-two LC were converted to open laparotomy (6.83%). Reasons for conversion included technical difficulties, aberrant biliary anatomy, dense scarring related to severe cholecystitis, biliary injuries and significant operative bleeding. Our primary endpoint was to evaluate the level of post-operative discomfort along with patient satisfaction from an aesthetic standpoint.
  
  
  RESULTS
  Postoperative pain was comparable to LC while subcuticular running sutures ensured acceptable cosmetic results. Medium hospital stay was 24 hours. Both operative and recovery times were comparable to LC and postoperative liver function tests and routine labs did not differ significantly from the preoperative checks.
  
  
  CONCLUSIONS
  The "so called" MIVAC approach appears to be a valid alternative to traditional open cholecystectomy whenever conversion to laparotomy becomes mandatory during the course of LC.
authors: Division of General Surgery and Organ Transplantation, Department of Surgical Sciences, Parma University Hospital, Italy. marco.zannoni@unipr.it
authors: M
authors: M
authors: Zannoni
authors: L
authors: L
authors: Viani
authors: C
authors: C
authors: Caramatti
authors: M
authors: M
authors: Iaria
authors: M
authors: M
authors: Sianesi
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D020535:Video-Assisted Surgery