GallstoneCommonbileduct.PDFVIP

Gallstone Common bile duct stones Edward C.S. Lai MS (HKU); FRCS(Ed); FRACS; FCSHK; FHKAM; FACS Symptomatic gallstone Flatulent dyspepsia Recurrent epigastric pain Documented acute cholecystitis History of CBD stone Asymptomatic gallstone DM Calcified gallbladder wall – “ Porcelin” gallbladder Large gallbladder polyp 1 cm Patient request Gallstone : Indications for cholecystectomy Ultrasound observations Adherent to gallbladder wall not floating in gallbladder lumen No acoustic shadow behind lesion Lesion 1 cm : Risk of malignant change Gallbladder polyps Laparoscopy Mini-laparotomy Operating time 0 2 Postoperative analgesic 3 0 Hospital stay 2 0 Return to work 2 0 Pulmonary function 1 0 Barkun; Lancet, 1992 (Montreal) McMahon; Surgery, 1994 (Scotland)# McGinn; Br J Surg, 1995 (Southampton) Majeed; Lancet, 1996 (Sheffield)) All no. shown = no. of study Operating time : 69-86 min Total no. of patients : 812 Laparoscopic cholecystectomy : Laparosocpy vs Mini-laparotomy No. of patients Conversion (%) Complication (%) Bile duct injury (%) Cushieri 1238 3.6 1.6 0.32 SSC 1516 4.7 5.1 0.5 Larson 1983 4.5 2.1 0.25 Kimura 1989 2.7 10.8 0.55 Barkun 1300 6.2 4.8 0.38 Laparoscopic cholecystectomy : Summary of results 10 mm 5 mm 3 mm 2 mm A safe and effective procedure for elective patients One 3-mm port is necessary for corresponding scope (Hopkins rod system) + Optional camera Use of classical 4-port technique allows best exposure for safe definition of anatomy at Carlot’s triangle Pain reduction is dubious from available data Needlescopic surgery offers the least possible trauma + best possible cosmetic results Lai; HK Med J, 2003 Needlescopic Cholecystectomy : Current status SPAS Single Port Access Surgery SIMPLE Single Incision Multi-Port Laparo-Endoscopic Surgery LESS Laparo-Endoscopic Single Site Surgery SILS Single Incision Laparoscopic Surgery Single Incision Laparoscopic Surgery : Synonyms SILS cholecystectomy: Choices of Singl