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laparoscopic cholecystectomy in situs inversus totalis with “inferior” cystic artery: A case report

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World Journal of Gastroenterology 2005年第33期11卷 5232-5234页

作者： Sumihiro Kamitani Yosihiro Tsutamoto Kazuyoshi Hanasawa Tohru Tani First Department of Surgery Shiga University of Medical Science Japan

A 76-year-old man with known situs inversus totalis presented with leE-sided discomfort. Abdominal ultrasonography and CT scan confirmed the diagnosis of a gallstone, as well as, situs inversus; the liver and gallbladder on the left side and the spleen on the right. The biliary system was thought to be left-right reversal, mirror image in the view of drip infusion cholangiogram and MRI. laparoscopic cholecy stectomy was safely performed, despite of unexpected aberrant cystic artery running inferior to cystic duct of situs inversus. laparoscopic surgeon should be careful for view of reversed relationships and also existence of other anomalies.

关键词： Situs inversus totalis laparoscopic cholecystectomy Inferior cystic artery

laparoscopic cholecystectomy for gangrenous cholecystitis in around nineties: Two case reports

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World Journal of Clinical Cases 2021年第14期9卷 3424-3431页

作者： Hiroyuki Inoue Toshiya Ochiai Hidemasa Kubo Yusuke Yamamoto Ryo Morimura Hisashi Ikoma Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectual University of MedicineKyoto 6028566Japan Department of Surgery North Medical Center Kyoto Prefectural University of MedicineKyoto 6292261Japan Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKyoto 6028566Japan

BACKGROUND Gangrenous cholecystitis is a form of acute cholecystitis which involves gangrenous alterations in the gallbladder wall and it often follows an acute and serious *** herein report on two cases of very elderly people diagnosed early with gangrenous cholecystitis,who safely underwent laparoscopic cholecystectomy(LC)and both demonstrated a good *** SUMMARY Case 1:An 89-year-old *** underwent abdominal contrast-enhanced computed tomography(CECT)due to abdominal pain and *** gallbladder wall indicated the absence of contrast enhancement,thus leading to diagnosis of gangrenous cholecystitis and she therefore underwent *** her gallbladder demonstrated diffuse necrosis and it was also partly perforated,she was able to be discharged without any serious *** 2:A 91-year-old *** made an emergency visit with a chief complaint of abdominal *** CECT revealed swelling of the gallbladder and an ambiguous continuity of the gallbladder *** was diagnosed with gangrenous cholecystitis and underwent *** gallbladder had swelling and diffuse *** her preoperative blood culture was positive,she showed a good outcome following *** Although a definite diagnosis of gangrenous cholecystitis is difficult to make prior to surgery,if an early diagnosis can be made and appropriate treatment can be carried out,then even very elderly individuals may be discharged without major complications.

关键词： Gangrenous cholecystitis laparoscopic cholecystectomy Elderly people Critical view of safety Tokyo guidelines 2018 Case report

laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrenceassociated risk factors

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World Journal of Gastrointestinal Surgery 2024年第11期16卷 3511-3519页

作者： Jia-Hua Liao Ju-Shi Li Tie-Long Wang Wen-Shen Liu Department of Hepatobiliary Surgery Shaoyang Central HospitalShaoyang 422000Hunan ProvinceChina Department of Organ Transplantation The First Affiliated Hospital of Sun Yatsen UniversityGuangzhou 510080Guangdong ProvinceChina

BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical *** To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bile duct exploration(CBDE)for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone *** Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were *** them,patients treated with open choledocholithotomy plus LC or open cholecystectomy(OC)were set as the control group(n=40),and those treated with LC plus CBDE served as the observation group(n=42).The surgical outcomes of the two groups were compared,the surgical complications and Gas-trointestinal Quality of Life Index(GIQLI)scores were counted,and the one-year prognostic recurrence was *** factors for postoperative re-currence were determined using univariate and multivariate *** The two groups were comparable in the stone residual rate(P>0.05).The ope-ration time(P<0.05),intraoperative bleeding(P<0.05),and total complication rate(P=0.005)were lower in the observation group than in the control *** observation group exhibited a marked increase in the GIQLI score,which was higher than the control group(P<0.05).A lower one-year recurrence rate was determined in the observation group vs the control group(P=0.027).Sphincter of Oddi dysfunction[odds ratio(OR)=5.712,P=0.007]and the treatment scheme of open choledocholithotomy plus LC or OC(OR=6.771,P=0.008)were the independent risk factors for one-year recurrence in patients after *** LC plus CBDE for patients with EHBDSs can reduce stone residuals,intraoperative bleeding,complications,and postoperative recurrence.

关键词： laparoscopic cholecystectomy Common bile duct exploration Extrahepatic bile duct stones Stone recurrence

laparoscopic cholecystectomy in Situs Inversus Totalis:a Case Report

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Chinese Medical Sciences Journal 2013年第4期28卷 245-247页

作者： Sheng-ning Zhang Li Li Jiang-hua Ran Jing Liu Yu Liang Yang Gao Min-jie Yang First Department of Hepatobiliary Pancreatic Surgery Affiliated Ganmei Hospital of Kunming Medical University First People’s Hospital of Kunming City Liver Transplantation Center of Organ Transplantation Institute of Yunnan Province

SITUSinversus totalis is uncommon anatomic anomaly, with gallbladder on the left side} Since the first known laparoscopic cholecystectomy in a patient with situs inversus has been reported by Camposand Sipes in 1991,2 there have been only approximately 40 cases of laparoscopic cholecystectomy performed in patients with situs inversus reported in the published literatures.3＇ 4 These cases may cause difficulties in the diagnostic and therapeutic management due to the mirror-image anatomy during operation, which requires more technically procedures and needs reorientation of visuomotor skills to the left upper quadrant. We herein discuss technical and diagnostic difficulties and review the literatures.

关键词： laparoscopic cholecystectomy sims inversus totalis

laparoscopic cholecystectomy based on Laennec approach via the cystic plate with lymphadenectomy in Calot's triangle for gallbladder neoplasms:Initial experience and technical details

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iLIVER 2023年第4期2卷 202-207页

作者： Bin Ouyang Laizhu Zhang Yajuan Cao Zhongjie Xing Jin Peng Yang Yue Decai Yu Nanjing Central Hospital Nanjing 210008China The Affiliated Drum Tower Hospital Nanjing University Medical SchoolNanjing 210008China

Background:It is still challenging to define the exact stage of early gallbladder carcinoma with preoperative ***,subserous gallbladder is dissected for the potential early gallbladder carcinoma,which may cause incomplete tumor resection or tumor spread especially for the patients with T2 ***,we reported our experience and safety of Laennec approach via the cystic plate to dissect the whole gallbladder with lymphadenectomy in Calot's triangle for accurate diagnosis and stage in gallbladder ***:The anatomical gap between Laennec capsule and the cystic plate serves as the landmark to dissect the whole gallbladder through Laennec *** cholecystectomy based on Laennec approach via the cystic plate,together with lymphadenectomy in Calot's triangle,was performed in 17 patients with gallbladder ***:All patients had less intraoperative bleeding,no gallbladder breakage,no bile leakage,and accurate intraoperative rapid pathological staging under the corresponding *** duration of surgery was comparable to that of traditional laparoscopic ***:laparoscopic cholecystectomy based on Laennec approach via the cystic plate,together with lymphadenectomy in Calot's triangular is safe for gallbladder *** the future,the prospective clinical trial is going on to confirm the feasibility and effectiveness of this approach.

关键词： Laennec approach Cystic plate laparoscopic cholecystectomy Gallbladder neoplasms Patient safety

Single-incision laparoscopic cholecystectomy:Single institution experience and literature review

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World Journal of Gastroenterology 2010年第2期16卷 270-274页

作者： Yasumitsu Hirano Toru Watanabe Tsuneyuki Uchida Shuhei Yoshida Kanae Tawaraya Hideaki Kato Osamu Hosokawa Department of Surgery Yokohama Sakae Kyousai Hospital132 Katsura-choSakae-kuYokohamaKanagawa 247-8581Japan

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic *** report one of the initial clinical experiences in Japan with this new *** cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible *** 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the *** was performed using an electric cautery hook and an Endograsper *** were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative *** all cases,there was no need to extend the skin *** operative time was 88.8 *** follow-up didnot reveal any umbili-cal wound ***-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.

关键词： laparoscopic cholecystectomy Incision Single-incision laparoscopic cholecystectomy Singleincision laparoscopic surgery Single-incision endoscopic surgery Minimally invasive surgery

Perineural dexamethasone does not enhance the analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block during laparoscopic cholecystectomy

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Hepatobiliary & Pancreatic Diseases International 2016年第5期15卷 540-545页

作者： Sheng-Hui Huang Jing Lu Hong-Yun Gan Yi Li Yong-Gang Peng Shuan-Ke Wang Department of Anesthesiology Second Hospital of Lanzhou University Lanzhou 730030 China Department of Anesthesiology Sichuan Provincial People’s Hospital and Sichuan Academy of Medical Sciences Chengdu 610072 China Morphology Teaching and Research Section Medical School Northwest University for Nationalities Lanzhou 730000 China Department of Anesthesiology Shands Hospital at the University of Florida Florida USA Department of 0rthopedics Second Hospital of Lanzhou University Lanzhou 730030 China

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block is an adjunct therapy to provide effective postoperative analgesia in abdominal surgical procedures. Dexamethasone is a supplement agent that can improve the efifcacy of local anesthesia. However, information about its additive effect is limited. This study aimed to compare the an-algesic efifciency using ultrasound-guided TAP block with and without perineural dexamethasone for patients who under-went laparoscopic cholecystectomy. METHODS: Sixty patients who underwent laparoscopic cho-lecystectomy were randomly divided into three groups: group I, controls; group II, TAP; and group III, TAP+perineural dexamethasone supplement. The requirement of additional analgesia and the ifrst-time request of rescue-analgesia were recorded after operation and the numerical rating scale was evaluated at speciifc intervals. RESULTS: Compared to group I, the ifrst-time requirement of rescue-analgesia in groups II and III was signiifcantly delayed (403.0±230.9, 436.0±225.3 vs 152.3±124.7,P0.05). CONCLUSION: Perineural dexamethasone has no additive/synergistic effect with subcostal TAP block on analgesic efif-cacy for the patients undergoing laparoscopic cholecystectomy.

关键词： ultrasonography local analgesic laparoscopic cholecystectomy dexamethasone

New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy

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World Journal of Gastroenterology 2007年第42期13卷 5629-5634页

作者： You-Ming Ding Bin Wang Wei-Xing Wang Ping Wang Ji-Shen Yan Department of Hepatobiliary & laparoscopic Surgery Renmin Hospital of Wuhan University Wuhan 430060 HubeiProvince China

AIM： To investigate the anatomic variations in the cystic artery by laparoscopy, and to provide a new classification system for the guidance of laparoscopic ***： Six hundred patients treated with laparoscopic cholecystectomy from June 2005 to May 2006 were studied retrospectively, The laparoscope of 30° （Stryker, American） was applied, Anatomic structures of cystic artery and conditions of Calot＇s triangle under laparoscope were recorded respectively,RESULTS： Laparoscopy has revealed there are many anatomic variations of the cystic artery that occur frequently. Based on our experience with 600 laparoscopic cholecystectomies, we present a new classification of anatomic variations of the cystic artery, which can be divided into three groups：（1） Calot＇s triangle type, found in 513 patients （85.5%）; （2） outside Calot＇s triangle, found in 78 patients （13%）; （3） compound type, observed in 9 patients （1.5%）.CONCLUSION： Our classification of the anatomic variations of the cystic artery uncontrollable cystic artery extrahepatic bile duct injury. will be useful for decreasing hemorrhage, and avoiding extrahepatic bile duct injury.

关键词： Cystic artery laparoscopic cholecystectomy Bile duct injury Calot's triangle

Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly

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World Journal of Gastroenterology 2009年第6期15卷 722-726页

作者： Hyung Ook Kim Jung Won Yun Jun Ho Shin Sang Il Hwang Yong Kyun Cho Byung Ho Son Chang Hak Yoo Yong Lai Park Hungdai Kim Departments of Surgery Kangbuk Samsung Hospital Sungkyunkwan University School of MedicineSeoul 110-746 South Korea Departments of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoul 110-746South Korea

AIM:To evaluate the outcome of laparoscopic cholecystectomy(LC)in patients aged 80 years and older. METHODS:A total of 353 patients aged 65 to 79 years(group 1)and 35 patients aged 80 years and older(group 2)underwent *** were further classified into two other groups:those with uncomplicated gallbladder disease(group A)or those with complicated gallbladder disease(group B). RESULTS:There were no significant differences between the age groups(groups 1 and 2)with respect to clinical characteristics such as age,gender,comorbid disease,or disease *** operative time,conversion rate,and the incidence of major postoperative complications were similar in groups 1 and ***,the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0%vs 5.7%,P<0.01).Group A comprised 322 patients with a mean age of 71.0±5.3 years,and group B comprised 51 patients with a mean age of 69.9±4.8 *** group B,mean operative time (78.4±49.3 min vs 58.3±35.8 min,P<0.01),mean postoperative hospital stay(7.9±6.5 d vs 5.0±3.7 d, P<0.01),and the incidence of major postoperative complications(9.8%vs 3.1%,P<0.05)were significantly greater than in group *** conversion rate tended to be higher in group B,but this difference was not significant. CONCLUSION:Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease,and not by chronologic *** octogenarians,LC should be performed at an earlier,uncomplicated stage of the disease whenever possible to improve perioperative outcomes.

关键词： Elderly laparoscopic cholecystectomy Octogenarians Gallbladder Cholecystitis