Laparoscopic Cholecystectomy explained
Laparoscopic cholecystectomy was performed for the first time in 1987 in Lyon by P. Mouret.
Laparoscopy term comes from the Greek words “laparos” (abdomen) and “skepeios” (to see, to observe). Laparoscopy means viewing the peritoneal cavity (abdominal) with an optical intrument (laparoscope) inserted into the abdomen through the abdominal wall. Laparoscopic cholecystectomy means performing gallbladder extirpation by laparoscopic surgery.
Laparoscopic cholecystectomy is not different by the classic surgery, only by the means of achieving which leads to a much lower injury, because it is not required a long incision of the abdominal wall and there are avoided maneuvers and tractions on abdominal viscera.
How is this surgery performed?
The surgery is performed under general anesthesia, with careful monitoring of biological constants. An essential element is the creation of an artificial space between the viscera (organs) and abdominal wall into the peritoneal cavity through the introduction of a gas (CO2) under pressure. This space allows both a very good view of the gallbladder and also for surrounding organs and a good handling and placing of surgical instruments. The introduction of gas is made through a needle that traverses the abdominal wall and connected to an insufflation system.
By an 1-1.5 cm incision at the umbilicus is crossed the abdominal wall with a trocar through which the laparoscope will be inserted. This tool is a metal tube of 10 mm in diameter, equipped with an optical system that allows both light diffusion in the abdomen, and receiving images of the abdomen through a lens – lens located at the distal end of the instrument. Through a transmission circuit, the image reaches the distal end of the laparoscope (located outside the abdomen), which is connected to a miniaturized video camera. Video camera takes pictures and sends them on a TV monitor.
Through the other three incisions (of 0.5-1 cm) are placed in the abdomen three trocars through which will enter and manipulate the tools necessary for proper execution of surgery: surgical forceps, scissors, electrocautery, applicator of clips, cannula for wash-vacuum.
The surgeon has a very clear and enlarged picture on the monitor of the gallbladder, ensured by a second surgeon who handles the laparoscope with the camcorder, following the operation step by step. The second aid is handling traction clamps and exposes the organ in the most favorable position. The surgeon dissects, using forceps, cystic duct and cystic artery, and then applies clips followed by sectioning with scissors. After this maneuver, gallbladder is disected from liver. Hemostasis (stop of bleeding) is done with electrocautery. After complete detachment of the gallbladder, it is removed from the abdomen through the bigest cannula. The surgery field is controled and the next step is to remove from the abdomen the instruments and trocars. At the end of surgery the skin wounds are sutured.
The advantages of laparoscopic surgery compared to classic operation
- is avoided a long incision of 10-20 cm of the abdominal wall which is replaced by four separate incisions of about 0.5-1.5 cm. It greatly reduces postoperative wound pain and wound complications (infections), postoperative respiratory complications, eventrations risk disappears.
- the patient can be fed from day one.
- complications are few, the patient can mobilize a few hours after surgery, hospitalization time is reduced to 2-3 days.
- After 7-10 days the patient can resume work.
- the cost is much lower.
Cholecystectomy has some drawbacks, however: the method can not be applied in all cases, and is reserved in principle only for uncomplicated cases without associated diseases.