Technical Aspects of Simultaneous Laparoscopic Surgeries in Patients with Cholelithiasis and Concomitant Surgical Abdominal Pathology

M.Yu. Nychytaylo, M.S. Zagriychuk, I.I. Bulyk, Yu.I. Masyuk, A.V. Goman

Abstract


In this article own experience of simultaneous laparoscopic procedures was analyzed in period of time from 2005 to 2012. Some technical details of surgical operation were given, especially first port placement technique and position of another laparoscopic instruments in the abdominal cavity. Implementation of such a technique improved results of the surgical treatment in patients with cholelithiasis and other simultaneous surgical diseases of abdominal cavity.
By the data of the World Health Care Organization nearly 30 % of all surgical patients have more then two surgical disorders in the same time. But real number is much more higher, because not all patients with cholelithiasis are observed. Treatment of these patients has many undecided questions, especially technical aspects during surgery. In our department we performed 181 different simultaneous operations, such as laparoscopic cholecystectomy and hepatic cyst fenestration, laparoscopic cholecystectomy and adrenalectomy and many others. And in order to perform surgery with maximal result we create some technical approaches in performing simultaneous operations. Implementation of these methods in our clinical practice increased number of simultaneous laparoscopic surgeries more then twice for the last five years.
First technical approach is using dynamic ultrasound scan before and during surgery in patients, who previously underwent different surgical procedures on abdominal cavity. Permanent intrasurgical ultrasound control leads to decreasing of abdominal organ damaging during pneumoperitoneum creation and laparoscopic ports implementation. Abdominal organs damage during these necessary steps has decreased more than three times.
Another technical aspect is correct laparoports placement for performing simultaneous laparoscopic procedures. In this article we described and provide pictures, which shows were laparoports has to be inserted in abdominal cavity for performing simultaneous laparoscopic cholecystectomy and another surgical operations, for example laparoscopic right or left adrenalectomy, laparoscopic right or left hepatic lobe fenestration, laparoscopic pancreatic cyst fenestration, laparoscopic gynecological procedures, laparoscopic hernia repair. Main aim of these technical aspects is to provide surgeon with effective using of laparoscopic instruments. Patients position during surgery has not to be changed, laparoscopic instruments amplitude need to be as wide as possible and surgery has to be maximum easily perform for surgeon. Also, number of troacars has to be minimal, but should not complicate performing of surgery. Thus, for laparoscopic cholecystectomy usually we insert four ports and for laparoscopic hernia repair we use three ports. By using correct places for port insertion in abdominal cavity we use only 5 laparoports instead of seven, and surgery can be easily done. 

Also we modified some classification of simultaneous laparoscopic operations. We divide all simultaneous laparoscopic procedures on fully simultaneous laparoscopic operations, when two or more surgical procedures were perform laparoscopically; simultaneous laparoscopic combine operations, when one disorder has been treated laparoscopically, and another one was corrected by using traditional laparotomy approach, and simultaneous laparoscopic joint operations — when abdominal surgical problem, for example cholelithiasis, has been treated laparoscopically, and another one, non-abdominal pathology, for example trombophlebitis, was treated traditionally, but during one surgical intervention and under one anesthesia. 

In our opinion, this classification is easy for using in day-by-day clinical practice. 

We also evaluated our results in patients, who underwent simultaneous laparoscopic procedures in our clinic for the last five years. We could not see the different in patients, who underwent simultaneous laparoscopic cholecystectomy and, for example, laparoscopic hepatic cyst fenestration comparing to patients, who has laparoscopic cholecystectomy alone. Intraoperative complications rate, postoperative rate, quality of life after surgery, postoperative pain severity, time of hospital stay and many other important criteria were almost the same in all three groups of patients. 

As a result of our research we conclude, that simultaneous laparoscopic operation is a method of choice in surgical treatment of patients with gallbladder disorders and another surgical diseases of abdominal cavity. This method of treatment is safe, effective, and can be used in every day surgical practice. Implementation of our technical aspects gives surgeon an opportunity to perform simultaneous laparoscopic operation more easily and to perform broad spectrum of surgical operations.

ments. Patients position during surgery has not to be changed, laparoscopic instruments amplitude need to be as wide as possible and surgery has to be maximum easily perform for surgeon. Also, number of troacars has to be minimal, but should not complicate performing of surgery. Thus, for laparoscopic cholecystectomy usually we insert four ports and for laparoscopic hernia repair we use three ports. By using correct places for port insertion in abdominal cavity we use only 5 laparoports instead of seven, and surgery can be easily done. Also we modified some classification of simultaneous laparoscopic operations. We divide all simultaneous laparoscopic procedures on fully simultaneous laparoscopic operations, when two or more surgical procedures were perform laparoscopically; simultaneous laparoscopic combine operations, when one disorder has been treated laparoscopically, and another one was corrected by using traditional laparotomy approach, and simultaneous laparoscopic joint operations — when abdominal surgical problem, for example cholelithiasis, has been treated laparoscopically, and another one, non-abdominal pathology, for example trombophlebitis, was treated traditionally, but during one surgical intervention and under one anesthesia. In our opinion, this classification is easy for using in day-by-day clinical practice. We also evaluated our results in patients, who underwent simultaneous laparoscopic procedures in our clinic for the last five years. We could not see the different in patients, who underwent simultaneous laparoscopic cholecystectomy and, for example, laparoscopic hepatic cyst fenestration comparing to patients, who has laparoscopic cholecystectomy alone. Intraoperative complications rate, postoperative rate, quality of life after surgery, postoperative pain severity, time of hospital stay and many other important criteria were almost the same in all three groups of patients. As a result of our research we conclude, that simultaneous laparoscopic operation is a method of choice in surgical treatment of patients with gallbladder disorders and another surgical diseases of abdominal cavity. This method of treatment is safe, effective, and can be used in every day surgical practice. Implementation of our technical aspects gives surgeon an opportunity to perform simultaneous laparoscopic operation more easily and to perform broad spectrum of surgical operations.  

References


Geiger M. Laparoscopic resection of colon cancer and synchronous liver metastasis / M. Geiger, D. Tebb, E. Sato, W. Miedema, T. Awad //

J. Laparoendosc. Adv. Surg. Tech. — 2006. — 16(1). —

P. 51-3.

Kim H. Laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases: initial experience / H. Kim, B. Lim, H. Ha, S. Han, J. Park, S. Choi, Y. Jeong // World J. Surg. — 2008. — 32(12). —

P. 2701-2706.

Romero R. Laparoscopic treatment of simultaneous tumors in the liver and kidney / R. Romero, A. Wagner, S. Bagga, M. Muntener, A. Brito, R. Kavoussi // Urol. Int. — 2007. — 79(2). — P. 142-144.

Wolosker N. Infrarenal aortic aneurysm repair by retroperitoneal approach combined with laparoscopic cholecystectomy: two case reports / N. Wolosker, K. Nishinari, B. Ferrari, L. Nakano // J. Laparoendosc. Adv. Surg. Tech. — 2001. — 11(2). — P. 115-117.

Takeyuki M. Simultaneous Operation of Laparoscopic Fenestration of Hepatic Cyst and Laparoscopic Cholecystectomy / M. Takeyuki, K. Yoshida, S. Kohno, M. Matsuda // Surgical Laparoscopy Endoscopy & Percutaneous Techniques. — 1994. — 4(6). — P. 497.

Zhang K. Laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct and traditional open operation / K. Zhang, S. Zhang, Y. Jiang, P. Gao // World J. Gastroenterol. — 2008. — 14(7). — P. 1133-1136.




DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87450

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