title: Double incision laparoscopic cholecystectomy (DILC) with routinary intra-operative cholangiography (IOC) : less trauma, same safety. Report on 30 consecutive non-selected cases.
abstract: Laparoscopic approach for cholecystectomy is, actually, the gold standard for gallbladder surgical benign diseases. Single transumbilical incision can further reduce abdominal wall trauma. Two main related issues are still to be enlighten: difficulty in obtaining a clear exposure of the Calot's triangle and routinely use of intra-operative cholangiography (IOC). A standardized technique of double incision laparoscopic cholecystectomy (DILC) with routine IOC is described. Between January and May 2012, 30 consecutive patients scheduled for elective cholecystectomy underwent DILC with IOC. Exclusion criteria were: clinical and/or radiological suspect of gallbladder malignancy/acute cholecystitis (AC)/common duct stones; ASA > 3; previous extensive abdominal surgery. Follow-up was performed at 7, 30 and 60 days postoperatively. Three 5-mm trocars through the umbilicus and one 3-mm subcostally on the right are used, along with a 30° laparoscopic camera. IOC is performed through the 3-mm channel. Median age was 49.5 years (range 24-78); female/male was 21/9. Median BMI was 27.4 (range 16.2-38.9). AC was encountered in five cases (17 %). Synchronous AC and choledocolithiasis occurred in one case (3 %), requiring conversion to laparoscopic choledocolithotomy. Additional ports were required in these latter five patients (17 %). IOC was routinely attempted in all patients, succeeding in 26 (86 %). Median operative 'skin to skin' time was 47.8 min (range 25-75). In the subgroup not receiving IOC, median operative time was 35 min (range 25-45); 51.5 min as median time (range 25-75) was reported for the subgroup undergone the entire planned procedure. No intraoperative complications occurred. Median length of stay was 1.51 days (range 1-5). Postoperative minor complications occurred in three patients (10 %) and wound umbilical infection occurred in one (3.4 %). DILC with the routine use of IOC seems to be repeatable and safe. Even if DILC seems more easily learnt, further studies are needed to address this issue.
authors: UOC di Chirurgia Generale e Videochirurgia, Ospedale San Giacomo, Castelfranco Veneto, TV, Italy. dariusque@fastwebnet.it
authors: Dario
authors: D
authors: D'Antonio
authors: Boris
authors: B
authors: Franzato
authors: Grazia
authors: G
authors: Fusco
authors: Mariangela
authors: M
authors: Ruperto
authors: Aldo
authors: A
authors: Dal Pozzo
mesh_terms: D000328:Adult; D000368:Aged; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
references: Surg Oncol Clin N Am. 2001 Jul;10(3):483-92
references: 11685923
references: Surg Endosc. 2008 Nov;22(11):2462-5
references: 18247090
references: Am J Surg. 2011 Jul;202(1):45-52
references: 21600559
references: Surg Endosc. 2002 Jul;16(7):1098-104
references: 12165830
references: Surg Endosc. 2011 Feb;25(2):367-77
references: 20607556
references: Surg Endosc. 2009 Jul;23(7):1660-6
references: 19415381
references: Arch Surg. 2006 Dec;141(12):1207-13
references: 17178963
references: JSLS. 2009 Oct-Dec;13(4):528-35
references: 20202394
references: Surg Endosc. 2012 May;26(5):1193-200
references: 22437958
references: J Gastrointest Surg. 2009 Sep;13(9):1733-40
references: 19412642
references: J Am Coll Surg. 1997 Jun;184(6):571-8
references: 9179112
references: Ann Surg. 2012 Jul;256(1):1-6
references: 22664556
references: Ann Surg. 2001 Oct;234(4):549-58; discussion 558-9
references: 11573048
references: Langenbecks Arch Surg. 2011 Aug;396(6):819-24
references: 21695591
references: J Am Coll Surg. 1995 Jan;180(1):101-25
references: 8000648
references: Am J Surg. 1991 Dec;162(6):576-9
references: 1670228
references: Hepatogastroenterology. 1997 Jan-Feb;44(13):22-7
references: 9058113
references: J Am Coll Surg. 2010 Jul;211(1):1-7
references: 20610242
references: Arch Surg. 2007 Sep;142(9):823-6; discussion 826-7
references: 17875836
references: JAMA. 2003 Oct 22;290(16):2168-73
references: 14570952
references: Aust N Z J Surg. 1997 Oct;67(10):706-11
references: 9322721
references: Arch Surg. 2005 Oct;140(10):986-92
references: 16230550
references: Br J Surg. 1997 May;84(5):695
references: 9171771
references: Gastrointest Endosc. 2007 Dec;66(6):1243-5
references: 17892873
references: Surg Endosc. 2010 Aug;24(8):1842-8
references: 20174950
references: Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):114-7
references: 22487622
references: J Nippon Med Sch. 2006 Jun;73(3):136-40
references: 16790980
references: BMC Surg. 2011 Sep 12;11:24
references: 21910897
references: Gastroenterol Clin Biol. 1996;20(4):339-45
references: 8758499
references: J Am Coll Surg. 2009 Nov;209(5):e1-6
references: 19854392