Abstract
Background
More than 10 years after its introduction, laparoscopic cholecystectomy has become the method of choice for the treatment of cholecystolithiasis. However intraoperative difficulties with dramatic postoperative consequences have been reported. The aim of this study was to identify what role the two-dimensional view, the surgeon’s experience, the instruments, technical tools and their (time) influence exercised on the operation course in daily laparoscopic operations.
Methods
The operative times for 30 laparoscopic cholecystectomies were investigated by ergonomic sequence analysis and analyzed statistically with the use of the Wilcoxon test.
Results
Comparing experienced and less experienced surgeons, a significant difference in the duration of the operation was observed (56±24 min compared to 75 ± 13 min, p=0.025), especially in the laparoscopic intra-abdominal phase of the operation. The prolonged duration of the operation (15–20%) was mainly due to problems with the technical tools (40%) and the use of instruments (23.5%). Visualization had a minor influence (14.4%) on the duration of the operation, and the negative effect of the two-dimensional view (0.5%) was negligible. The last two factors did not cause any complications.
Conclusions
The recognized difficulties still cause a loss of time and in some cases complications, which can only partly be compensated by the surgeon’s experience. This leads to reluctance in the application of laparoscopic cholecystectomy in more complicated stages of the disease. Two-dimensional view satisfies the surgeon’s demands for a safe procedure.
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References
Adamer K, Salzmann M, Imhof M, Zacherl J, Raduly F, Fugger R (1997) Postoperative benefit after laparoscopic cholecystectomy in acute cholecystitis. Zentralbl Chir 122: 287–290
Bueß GF, van Bergen P, Kunert W, Schurr MO (1996) Vergleichsstudie verschiedener 2-D und 3-D- Sichtsysteme in der minimal-invasiven Chirurgie. Chirurg 67: 1041–1046
Claus GP, Sjoerdsma W, Jansen A, Grimbergen CA (1995) Quantitative standardised analysis of advanced laparoscopic procedures. Endosc Surg Allied Technol 3: 210–213
Davidoff AM, Pappas TN, Murray EA (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215: 196–202
Deyo GA (1992) Complications of laparoscopic cholecystectomy. Surg Laparosc Endosc 2: 41
Diebold M (1992) Anästhesiologische Aspekte bei der Laparoskopie. In: KH Fuchs, H Hamelmann, BC Manegold (eds) Chirurgische endoskopie im abdomen. Blackwell Wissenschaft, Berlin, pp 273–276
Fuchs KH, Freys SM, Schaube H, Hamelmann H (1992) Laparoskopische Cholezystektomie: Einführung und Etablierung einer neuen Methode. In: KH Fuchs, H Hamelmann, BC Manegold (eds) Chirurgische endoskopie im abdomen. Blackwell Wissenschaft., Berlin, pp 343–363
Gilliand TM, Traverso W (1990) Modern standards for comparison of cholezystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long term relief of symptoms. Surg Gynecol Obstet 170: 39–44
Keisuke A (1993) Abdominal wall retraction during laparoscopic cholecystectomy. World J Surg 17: 105–108
Kirchner JH, Rohmert W (1973) Problemanalyse zur Erarbeitung eines arbeitswissenschaftlichen Instrumentariums für Tätigkeitsanalysen. In: Bundesinstitut für Berufsbildungsforschung Arbeitswissenschaftliche Studien zur Berufsbildungsforschung Gebr. Jänecke Verlag, Hannover, pp 7–48
Largiader F (1991) Neue operative und nichtoperative Möglichkeiten zur Behandlung von Gallenblasensteinen. Schweiz Rundsch Med 80: 318–321
Larson WL, Simonet P (1992) Clinical measurement of depth perception by means of motion parallax: a case report. Optomal Vis Sci 69: 248–249
McSherry CK (1992) Open cholecystectomy. Am J Surg 165: 435–439
Pier A, Götz F (1992) Laparoskopische Cholezystektomie: Indikationen und Komplikationen. In: KH Fuchs, H Hamelmann, BC Manegold (eds) Chirurgische endoskopie im abdomen. Blackwell Wissenschaft. Berlin, pp 380–399
Ponce J, Cutshall KE, Hodge MJ, Browder W (1995) The lost laparoscopic stone: potential for long-term complications. Arch Surg 130: 666–668
Satava RM (1993) 3-D vision technology applied to advanced minimally invasive surgery systems. Surg Endosc 7: 429–431
Schietroma M, Carlei F, Ciuca B, Risetti A, Lannucci D, Leardi S, Muzi F, De-Santis C, Di-Placido R, Recchia CL, Maggi G, Simi M (1997) Video laparoscopic cholecystectomy in acute cholecystitis: when, how and why? Minerva Chir 52: 515–522
Schumpelick V, Schippers E (1991) Cholezystektomie: laparoskopisch oder konventionell? Z Gastroenterol 29: 659–662
von Pichler C, Rademacher K, Grablowitz V, Boekmann W, Rau G, Jakse G, Schumpelick V (1993) An ergonomic analysis of stereo-video-endoscopy, Proceedings of the 15th annual conference of the IEEE, San Diego, October 28–31, pp 1408–1409
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Online publication: 8 February 2002
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Welty, G., Schippers, E., Grablowitz, V. et al. Is laparoscopic cholecystectomy a mature operative technique?. Surg Endosc 16, 820–827 (2002). https://doi.org/10.1007/s00464-001-9019-4
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DOI: https://doi.org/10.1007/s00464-001-9019-4