Laparoscopic choledochotomy for treatment of common bile duct stones
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Journal Article↗
Biomedical subjects
JB Petelin
Publications and source records attributed to JB Petelin.
Techniques and Cost of Common Bile Duct Exploration.
The introduction of laparoscopic techniques to treat biliary tract disease in the last decade heralded the beginning of a new age of surgery where strong emphasis is placed not only on the efficacy of the operation, but at least as importantly on the "side effects" of surgical intervention. Thus, the focus has recently centered on the application of minimally invasive and minimally damaging techniques to perform operations that heretofore had required laparotomy. Laparoscopic cholecystectomy (LC) itself is an excellent example of a procedure that produces an equivalent disease-related treatment endpoint, without the morbidity of previous "open" techniques. Laparoscopic treatment of common bile duct stones, while technically much more difficult than cholecystectomy, offers the same minimally invasive benefits to the patient without the necessity of laparotomy or secondary procedures such as endoscopic retrograde choledocholithotomy or sphincterotomy. Numerous techniques for laparoscopic common bile duct exploration (LCDE) have been developed. Each of them accesses the stones by one of two routes: through the cystic duct or through a choledochotomy. Both approaches are associated with equivalent success rates in removing stones, but the transcystic approach has the added benefit of being truly minimally invasive, as compared with choledochotomy. This report reviews the current state of the art of the transcystic approach to the laparoscopic treatment of choledocholithiasis.
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Laparoscopic Adrenalectomy.
Adrenal pathology requiring surgical intervention is relatively uncommon. Nevertheless, there are a number of conditions that warrant such consideration. Most surgically correctable diseases of the adrenal glands are associated with excess production of adrenal corticosteroids or catecholamines by an adrenal tumor. Classic open approaches toward adrenalectomy in the past have included an anterior, transabdominal, or posterior route. Laparoscopic adrenalectomy offers the advantages of excellent exposure through minimally damaging portals. This results in an expected very benign postoperative course. It has now been almost 4 years since the first reported laparoscopic adrenalectomy. Since then, numerous small series have been reported and experienced laparoscopic surgeons have proven the merits of a laparoscopic approach to adrenalectomy. This reviews the current state of the art and offers descriptions of selected approaches to both the right and left adrenal glands.
Journal Article↗