Laparoscopic Cholecystectomy

Wolfe, Bruce M.; Gardiner, Barry N.; Frey, Charles F.

doi:10.1001/jama.2014.12014

Cited by 30 publications

(6 citation statements)

References 5 publications

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“…These present several benefits to the patient when it comes to blood loss, recovery time, post-operative trauma, scarring and wound site infection [5]. However, they can be challenging from the surgeons' point of view due to differences in ergonomic control, sensory feedback, dexterity and intuitiveness [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Challenges of continuum robots in clinical context: a review

et al. 2020

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With the maturity of surgical robotic systems based on traditional rigid-link principles, the rate of progress slowed as limits of size and controllable degrees of freedom were reached. Continuum robots came with the potential to deliver a step change in the next generation of medical devices, by providing better access, safer interactions and making new procedures possible. Over the last few years, several continuum robotic systems have been launched commercially and have been increasingly adopted in hospitals. Despite the clear progress achieved, continuum robots still suffer from design complexity hindering their dexterity and scalability. Recent advances in actuation methods have looked to address this issue, offering alternatives to commonly employed approaches. Additionally, continuum structures introduce significant complexity in modelling, sensing, control and fabrication; topics which are of particular focus in the robotics community. It is, therefore, the aim of the presented work to highlight the pertinent areas of active research and to discuss the challenges to be addressed before the potential of continuum robots as medical devices may be fully realised.

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Section: Introductionmentioning

confidence: 99%

Challenges of continuum robots in clinical context: a review

et al. 2020

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“…In 1882, Dr. Langenbuch performed the first cholecystectomy, which has been considered a significant routine surgery to eradicate gallstones. With the development of surgical technology, a laparoscopic cholecystectomy has become one of the most commonly performed surgical procedures worldwide [10]. However, cholecystectomy is invasive and has a risk of postoperative complications, and not all patients with symptomatic gallstones are candidates for surgery [11].…”

Section: Introductionmentioning

confidence: 99%

The effect of ursodeoxycholic acid on the relative expression of the lipid metabolism genes in mouse cholesterol gallstone models

et al. 2020

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Background Many studies indicate that gallstone formation has genetic components. The abnormal expression of lipid-related genes could be the basis for particular forms of cholesterol gallstone disease. The aim of this study was to obtain insight into lipid metabolism disorder during cholesterol gallstone formation and to evaluate the effect of ursodeoxycholic acid (UDCA) on the improvement of bile lithogenicity and its potential influence on the transcription of lipid-related genes. Methods Gallstone-susceptible mouse models were induced by feeding with a lithogenic diet (LD) for 8 weeks. Bile and liver tissues were obtained from these mouse models after 0, 4 and 8 weeks. Bile lipids were measured enzymatically, and the cholesterol saturation index (CSI) was calculated to evaluate the bile lithogenicity by using Carey’s critical tables. Real-time polymerase chain reaction (RT-PCR) was used to detect the mRNA expression levels of farnesoid X receptor (FXR), liver X receptor (LXR), adenosine triphosphate-binding cassette subfamily G member 5/8 (ABCG5/8), cholesterol 7-α hydroxylase (CYP7A1), oxysterol 7-α hydroxylase (CYP7B1), sterol 27-α hydroxylase (CYP27A1), peroxisome proliferator-activated receptor alpha (PPAR-α) and adenosine triphosphate-binding cassette subfamily B member 11 (ABCB11). Results The rate of gallstone formation was 100% in the 4-week group but only 30% in the UDCA-treated group. The UDCA-treated group had a significantly lower CSI compared with other groups. Of special note, the data on the effects of UDCA showed higher expression levels of ABCG8, ABCB11 and CYP27A1, as well as lower expression levels of LXR and PPAR-α, compared to the model control group. Conclusions UDCA exhibits tremendously potent activity in restraining lipid accumulation, thus reversing the lithogenic effect and protecting hepatocytes from serious pathological damage. The abnormal expression of ABCG8, CYP7A1, CYP27A1, LXR and PPAR-α might lead to high lithogenicity of bile. These results are helpful in exploring new lipid metabolism pathways and potential targets for the treatment of cholesterol stones and for providing some basis for the study of the pathogenesis and genetic characteristics of cholelithiasis. Research on the mechanism of UDCA in improving lipid metabolism and bile lithogenicity may be helpful for clinical treatment and for reducing the incidence of gallstones.

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“…It can also cause liver injury, loss of bile or gallbladder perforation. 4 Ultrasonic (harmonic) scalpel was developed to resolve this issue. 5 Harmonic Dissector (HD) was introduced in 1992 by Ethicon Endo surgery USA, and surgeons have used this instrument in more than 14 million procedures worldwide.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Conventional Electrocautery Versus Ultrasonic Dissector in Laparoscopic Cholecystectomy

Anis

Rehman²,

Ahmad

et al. 2019

JIMDC

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Background: Laparoscopic cholecystectomy (LC) is very commonly performed for removal of gallstones. In routine, ultrasonic devices are used for laparoscopy involving the deeper operating fields, while electrosurgical devices are preferred for LC. However, nowadays both of these devices are used for LC. The objective of this study was to compare the surgical outcomes of ultrasonic dissector over conventional electrocautery in patients planned for LC. Material and Methods: This non-randomized clinical trial was conducted in general surgery unit, Jinnah hospital Lahore. The study duration was 15th January 2015 to 31st December 2016. In group A (n=100), patients were operated through three-port standard laparoscopic cholecystectomy and conventional electrosurgical cautery was used for dissection. While in group B (n=50), patients were operated through single incision laparoscopic surgery (SILS) and Harmonic dissector was used for sealing of cystic artery and cystic duct. SPSS version 23 was used for data analysis. Complications between electrocautery and ultrasonic dissector were compared using chi-square test/Fischer exact test and operative time was compared using student’s t-test with p-value ≤ 0.05 considered as statistically significant.Results: Out of 150 patients planned for laparoscopic cholecystectomy, 33 (22%) were males and 117 (78%) females. The mean age was 40±6.45 years with an age range of 12-80 years. In group A, intraoperative gall bladder perforation was found in 5 patients whereas in group B, there was only one patient with perforation. A total of 4 cases were converted to open cholecystectomy in group A due to difficult dissection in Calot’s triangle as compared to 1 case in group B. In group A, 3 cases had postoperative bile leakage in the drain. In two patients it settled over a period of 3 days. About 03 cases had wound infection in group A and 1 in group B. Mean operative time in group A was 42.2±8.93 minutes versus 35.7±4.85 minutes in group B (p-value 0.001).Conclusion: In this study, the rate of post-operative complications was similar between the two groups, but operative time was significantly shorter in the group B. Harmonic dissector enabled easy dissection of tissues with good hemostasis and less trafficking of instrument, avoiding use of clips and sutures during minimal invasive surgery.

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Laparoscopic Cholecystectomy

Cited by 30 publications

References 5 publications

Challenges of continuum robots in clinical context: a review

Challenges of continuum robots in clinical context: a review

The effect of ursodeoxycholic acid on the relative expression of the lipid metabolism genes in mouse cholesterol gallstone models

Comparative Study of Conventional Electrocautery Versus Ultrasonic Dissector in Laparoscopic Cholecystectomy

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