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Clinical outcomes of single incision laparoscopic cholecystectomy in the anglophone Caribbean: a multi centre audit of regional hospitals.

Cawich SO, Albert M, Singh Y, Dan D, Mohanty S, Walrond M, Francis W, Simpson LK, Bonadie KO, Dapri G - Int J Biomed Sci (2014)

Bottom Line: The mean operative time was 62.9 ± 17.9 minutes.There was no mortality, 2 conversions to multi-trocar laparoscopy and 5 minor complications.Ambulatory procedures were performed in 43/71 (60.6%) patients scheduled for elective operations.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of the West Indies, St. Augustine Campus, Trinidad & Tobago;

ABSTRACT

Introduction: There has been no report on Single-Incision Laparoscopic Surgery (SILS) cholecystectomy outcomes since it was first performed in the Anglophone Caribbean in 2009.

Methods: A retrospective audit evaluated the clinical outcomes of SILS cholecystectomies at regional hospitals in the 17 Anglophone Caribbean countries. Any cholecystectomy using a laparoscopic approach in which all instruments were passed through one access incision was considered a SILS cholecystectomy. The following data were collected: patient demographics, indications for operation, intraoperative details, surgeon details, surgical techniques, specialized equipment, conversions, morbidity and mortality. Descriptive statistics were generated using SPSS 12.0.

Results: There were 85 SILS cholecystectomies in women at a mean age of 37.4 ± 8.5 years with a mean BMI of 30.9 ± 2.8. There were 59 elective and 26 emergent cases. Specialized access platforms were used in the first 35 cases and reusable instruments were passed directly across fascia in the latter 50 cases. The mean operative time was 62.9 ± 17.9 minutes. There was no mortality, 2 conversions to multi-trocar laparoscopy and 5 minor complications. Ambulatory procedures were performed in 43/71 (60.6%) patients scheduled for elective operations.

Conclusion: In the Caribbean setting, SILS cholecystectomy is a feasible and safe alternative to conventional multi-trocar laparoscopic cholecystectomy for gallbladder disease.

No MeSH data available.


Related in: MedlinePlus

Sheared insulation (arrow) near the tip of an electrocautery hook allowing lateral discharge of energy during dissection.
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Figure 2: Sheared insulation (arrow) near the tip of an electrocautery hook allowing lateral discharge of energy during dissection.

Mentions: There was no mortality in this series. There were minor complications in 5 (5.9%) cases: 3 wound infections (Grade 1), 1 diaphragmatic laceration repaired with intra-corporeal sutures without conversion (Grade 2a) and 1 bile leak (Grade 2b). The bile leak occurred in a 45 year old woman who had multiple prior attacks of acute cholecystitis. Intra-operatively, a retrograde technique was used with a 30° rigid laparoscope and standard straight instrumentation. During the procedure, it was noted that the electrocautery hook was exposed due to shearing of the insulation near the instrument tip (Fig. 2). The instrument was immediately changed but bile was seen leaking from a common duct injury occupying 15-20% of the duct circumference - presumably from lateral discharge of energy during dissection in Calot’s triangle. A supplemental 5mm trocar was used to intubate the injury laparoscopically and the T-tube was brought through the trocar skin incision. This allowed adequate healing without the need for any additional procedures after 32 months of follow-up.


Clinical outcomes of single incision laparoscopic cholecystectomy in the anglophone Caribbean: a multi centre audit of regional hospitals.

Cawich SO, Albert M, Singh Y, Dan D, Mohanty S, Walrond M, Francis W, Simpson LK, Bonadie KO, Dapri G - Int J Biomed Sci (2014)

Sheared insulation (arrow) near the tip of an electrocautery hook allowing lateral discharge of energy during dissection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4199470&req=5

Figure 2: Sheared insulation (arrow) near the tip of an electrocautery hook allowing lateral discharge of energy during dissection.
Mentions: There was no mortality in this series. There were minor complications in 5 (5.9%) cases: 3 wound infections (Grade 1), 1 diaphragmatic laceration repaired with intra-corporeal sutures without conversion (Grade 2a) and 1 bile leak (Grade 2b). The bile leak occurred in a 45 year old woman who had multiple prior attacks of acute cholecystitis. Intra-operatively, a retrograde technique was used with a 30° rigid laparoscope and standard straight instrumentation. During the procedure, it was noted that the electrocautery hook was exposed due to shearing of the insulation near the instrument tip (Fig. 2). The instrument was immediately changed but bile was seen leaking from a common duct injury occupying 15-20% of the duct circumference - presumably from lateral discharge of energy during dissection in Calot’s triangle. A supplemental 5mm trocar was used to intubate the injury laparoscopically and the T-tube was brought through the trocar skin incision. This allowed adequate healing without the need for any additional procedures after 32 months of follow-up.

Bottom Line: The mean operative time was 62.9 ± 17.9 minutes.There was no mortality, 2 conversions to multi-trocar laparoscopy and 5 minor complications.Ambulatory procedures were performed in 43/71 (60.6%) patients scheduled for elective operations.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of the West Indies, St. Augustine Campus, Trinidad & Tobago;

ABSTRACT

Introduction: There has been no report on Single-Incision Laparoscopic Surgery (SILS) cholecystectomy outcomes since it was first performed in the Anglophone Caribbean in 2009.

Methods: A retrospective audit evaluated the clinical outcomes of SILS cholecystectomies at regional hospitals in the 17 Anglophone Caribbean countries. Any cholecystectomy using a laparoscopic approach in which all instruments were passed through one access incision was considered a SILS cholecystectomy. The following data were collected: patient demographics, indications for operation, intraoperative details, surgeon details, surgical techniques, specialized equipment, conversions, morbidity and mortality. Descriptive statistics were generated using SPSS 12.0.

Results: There were 85 SILS cholecystectomies in women at a mean age of 37.4 ± 8.5 years with a mean BMI of 30.9 ± 2.8. There were 59 elective and 26 emergent cases. Specialized access platforms were used in the first 35 cases and reusable instruments were passed directly across fascia in the latter 50 cases. The mean operative time was 62.9 ± 17.9 minutes. There was no mortality, 2 conversions to multi-trocar laparoscopy and 5 minor complications. Ambulatory procedures were performed in 43/71 (60.6%) patients scheduled for elective operations.

Conclusion: In the Caribbean setting, SILS cholecystectomy is a feasible and safe alternative to conventional multi-trocar laparoscopic cholecystectomy for gallbladder disease.

No MeSH data available.


Related in: MedlinePlus