• bile duct surgery
• common bile duct
• hem-o-lok
• lap cholecystectomy
• laparoscopic cholecystectomy complication

• Cystic duct
• Gallbladder diseases
• Laparoscopic cholecystectomy
• Minimally invasive surgical procedures

To explore the application effect of fast track surgery (FTS) care combined with continuous care after discharge in patients with laparoscopic cholecystectomy (LC).

Two hundred patients treated with LC in our hospital from May 2020 to September 2021 were selected and divided into the routine group receiving routine care (n = 100) and the combined group receiving FTS care combined with continuous care after discharge (n = 100) according to their care methods. We observed the care effect, surgical stress levels [epinephrine, cortisol, Hamilton anxiety scale (HAMA)], postoperative recovery (time to first exhaust, time to first meal, time to first getting out of bed, time to hospitalization), complications, SF-36 scores after discharge, and care satisfaction in both groups.

The total efficiency of care in the combined group was better than that in the routine group (P < 0.05). At 1 d after surgery, the levels of epinephrine and cortisol in both groups were significantly higher than those at 1 h before surgery, and the HAMA scores were significantly lower than those at 1 h before surgery, and the combined group was lower than the routine group (P < 0.05). The time to first exhaustion, time to first meal, time to first getting out of bed, and time to hospitalization were shorter in the combined group than in the routine group (P < 0.05). The overall complication rate in the combined group was lower than that in the routine group (P < 0.05). The each item of SF-36 scores after discharge were higher in the combined group than in the routine group (P < 0.05). The total satisfaction with care was higher in the combined group than in the routine group (P < 0.05).

The implementation of FTS care combined with continuous care after discharge in LC patients is ideal, which can significantly reduce the level of surgical stress, accelerate the recovery process, and reduce the occurrence of complications, and improve the postoperative quality of life of patients significantly, and with high satisfaction, which is worthy of application.

• children
• cholecystectomy
• cystic duct
• harmonic scalpel
• laparoscopic surgery

Laparoscopic cholecystectomy has replaced conventional open cholecystectomy and has become the gold standard surgery for gall bladder pathologies. The harmonic scalpel is one of the instruments used to dissect and coagulate. Most surgeons accept the usage of the harmonic scalpel in laparoscopic cholecystectomy. The other standard method is electrocoagulation by electrocautery. The harmonic scalpel cholecystectomy has several advantages over other methods of laparoscopic cholecystectomy. Electrocoagulation by electrocautery produces smoke which can result in damage to lateral tissues, including the gall bladder. The clips are used along with electrocoagulation to seal cystic duct and cystic artery before dissection. There are various studies about bile leakage in the case of clip application. The harmonic scalpel uses ultrasonic energy to achieve hemostasis without bleeding, dissection, and gallbladder removal from the liver bed during laparoscopic surgery by causing coagulation of proteins. The patient outcome variables such as postoperative pain, duration of hospital stay, postoperative nausea and vomiting, surgical site infections, and other complications have not been compared in review articles. In this review, we collected the information from previously published studies and reviewed the outcomes of patients undergoing harmonic scalpel cholecystectomy. Harmonic scalpel cholecystectomy reduces the duration of hospital stay, duration of operation, intraoperative and postoperative complications, and postoperative pain. Thus the harmonic scalpel can be used instead of other instruments as it has better patient outcomes.

• clip-less cholecystectomy
• conventional laparoscopic cholecystectomy
• harmonic scalpel
• laparoscopic cholecystectomy
• patient outcomes

• Bipolar sealing
• Laparoscopic
• Peritoneal tear sealing technique
• TAPP
• TEP

• Harmonic device
• Laparoscopic cholecystectomy
• Liver cirrhosis

• Harmonic device
• Laparoscopic cholecystectomy
• Liver cirrhosis

In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.

• Calot's triangle variations
• Moynihan's hump
• caterpillar hump of right hepatic artery
• cystic artery variations
• laparoscopic cholecystectomy

Clips inserted during laparoscopic cholecystectomy (LC) may migrate into the biliary system and function as a nidus for the formation of gallstones. Here, we present a series of 4 patients who presented with this rare complication 5–17 years after LC. All 4 patients presented with symptomatic choledocholithiasis with biochemical and radiological signs of biliary obstruction. Three patients also had fever and infectious parameters, compatible with concurrent cholangitis. All patients successfully underwent endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and stone extraction. Patients with cholangitis also had antibiotic treatment. In 3 patients, obstruction of the common bile duct was caused by a single, relatively large stone that had formed around a clip (supposedly the cystic duct clip). In 1 patient, multiple stones had formed around an intrabiliary migrated cluster of coils that had been used for arterial embolization of a pseudo-aneurysm of the right hepatic artery. In conclusion, surgical clips and coils can migrate into the biliary tract and serve as a nidus for the formation of bile duct stones. Although rare, this complication should caution surgeons not to place clips “at random” during cholecystectomy. Patients with this rare complication are best managed by ERCP in combination with sphincterotomy and stone extraction.

• Bile duct injury
• Cholecystectomy
• Clip migration
• Endoscopic retrograde cholangiopancreatography
• Foreign body migration

• Biliary surgery
• Cholecystectomy
• Cystic duct leakage
• Outcomes
• Prevention

• Bile duct injury
• Cholecystectomy
• Consensus
• Laparoscopy
• Recommendations

• Cholangiopancreatography, Endoscopic Retrograde
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Cholecystectomy, Laparoscopic/standards
• Consensus
• Female
• Humans
• Male
• Patient Safety
• Postoperative Complications/prevention & control
• Practice Guidelines as Topic/standards
• Preoperative Care/methods
• Risk Assessment
• Safety Management
• Societies, Medical

In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement.

To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver.

Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO₂ insuflation.

The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking.

The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.

• Acute cholecystitis
• Biliary surgery
• CBD complications
• Conversion rate
• Harmonic scalpel
• Laparoscopic cholecistectomy
• Randomized controlled trial
• Safety

• Acute cholecystitis
• Cholecystectomy
• Endo-GIA
• Stapler

• Adult
• Aged
• Cholecystectomy/instrumentation
• Cholecystitis, Acute/surgery
• Cystic Duct/surgery
• Female
• Fibrin Tissue Adhesive/therapeutic use
• Humans
• Length of Stay
• Ligation/instrumentation
• Male
• Middle Aged
• Surgical Staplers

Single-port laparoscopic cholecystectomy with a 10-mm telescope and inbuilt working channel has been found to be safe, effective, economical, and capable of producing virtually scarless results.

Multiple single-port or single-incision techniques have been successfully implemented for laparoscopic cholecystectomy in adults and children. These techniques require either a large multichannel port or a larger skin incision to accommodate multiple ports or instruments. Inspired by a first generation single-port instrument, we developed a safe and effective technique for a single-port laparoscopic cholecystectomy with virtually scarless results.

Over a 14-mo period, 20 patients (19 females, 1 male) underwent the hybrid single-port cholecystectomy. A straight 10-mm Storz telescope with inbuilt 6-mm working channel in combination with 2 portless 2.3-mm percutaneous graspers was used. The dissection is carried out with 43-cm bariatric length instruments. The cystic artery and duct are sealed with WECK Hem-o-lok clips or the Harmonic scalpel.

Range (mean) age: 7.7 y to 19.5 y (15.5), BMI: 11.6kg/m² to 42.3kg/m² (27), operative duration 48 min to 120 min (79), postoperative length of stay: 5 h to 78 h (24). Diagnosis: 13 patients cholecystolithiasis, 7 patients biliary dyskinesia. Conversion to conventional 4-port cholecystectomy was required in 2 patients. No intra- or postoperative complications occurred.

The hybrid single-port technique is easy to master. It provides traditional anatomical exposure and allows application of conventional laparoscopic principles.

• electrothermal bipolar vessel-sealing device
• ultrasonic shears
• biliary surgery

• Adult
• Aged
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/instrumentation
• Cholecystectomy, Laparoscopic/methods
• Female
• Gallstones/complications
• Gallstones/surgery
• Humans
• Intraoperative Complications
• Liver Cirrhosis/complications
• Male
• Middle Aged
• Postoperative Complications
• Surgical Instruments
• Ultrasonic Therapy/instrumentation
• Young Adult

• ultrasonic dissection
• electrocautery
• electrosurgical energy

• Cholecystectomy, Laparoscopic
• Dissection/instrumentation
• Dissection/methods
• Electrosurgery/instrumentation
• Electrosurgery/methods
• Humans
• Length of Stay
• Pain, Postoperative/epidemiology
• Randomized Controlled Trials as Topic
• Ultrasonics

• Adult
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/instrumentation
• Cholecystectomy, Laparoscopic/methods
• Cholecystitis, Acute/surgery
• Double-Blind Method
• Electrocoagulation/adverse effects
• Equipment Design
• Humans
• Prospective Studies
• Research Design
• Surgical Instruments
• Treatment Outcome
• Ultrasonics/adverse effects

AIM: To investigate the anatomic variations in the cystic artery by laparoscopy, and to provide a new classification system for the guidance of laparoscopic surgeons.

METHODS: 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 will be useful for decreasing uncontrollable cystic artery hemorrhage, and avoiding extrahepatic bile duct injury.

• Cystic artery
• Laparoscopic cholecystectomy
• Bile duct injury
• Calot's triangle

• Cholecystectomy, Laparoscopic/methods
• Cholelithiasis/surgery
• Common Bile Duct/surgery
• Equipment Design
• Gallbladder/blood supply
• Humans
• Laparoscopes
• Suture Techniques
• Treatment Outcome

• Animal Structures/pathology
• Animals
• Biopsy/methods
• Biopsy/veterinary
• Dogs/surgery
• Endoscopy/methods
• Endoscopy/veterinary
• Female
• Laparoscopy/methods
• Laparoscopy/veterinary
• Male