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PubMed · 12731233

[The difficult laparoscopic cholecystectomies--technical problems].

V Răzeşu
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Abstract

Referring to the difficult laparoscopic cholecistectomies, the author underlines the actuality of theme and the value of the dialogue between surgeons. The author discusses the anatomo-pathological formes, generating of intraoperative difficulties and emphasises that such historical interventions for difficult cholecistectomies, may be reactualised, with good results in practice. Punctually, he refers to some variants of cholecistectomy: cholecistendesis for sclero-atrophic cholecist and Pribram mucoclasic for cirrhotic patient. The author invites to debate these technical modalities which can evitate or limit, for determined situations, intraoperative risks or failure causes.

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Cholecystectomy, LaparoscopicGallbladder DiseasesHumansLiver CirrhosisTreatment OutcomeEnglish AbstractJournal Article

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V Răzeşu. [The difficult laparoscopic cholecystectomies--technical problems].. https://pubmed.ncbi.nlm.nih.gov/12731233/

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Itemized bill: novel method to audit the process of laparoscopic cholecystectomy.

One of the recurring obstacles to the successful completion of a medical audit cycle is the unavailability of accurate and complete information. This is particularly evident in the review of clinical processes, where the hand-written medical record is the source of information. We have attempted to bypass this information deficit by using information recorded primarily for financial transactions, using the itemized bill. The study was conducted in two parts. Initially information recorded as an itemized bill for the in-hospital process of laparoscopic cholecystectomies over a one-year period was analyzed. Areas for change in practice were identified, and recommendations were developed. These recommendations were presented to a multidisciplinary group consisting of consultants, residents, and nursing staff involved in caring for these patients. A clinical pathway was developed and implemented from these recommendations. One year after introduction, a review of the clinical pathway was undertaken using the same methodology. The in-hospital process consisted of 23 charge categories according to the itemized bill. Of these, 8 accounted for 95% of the total charge. The surgeon's fee and the anesthesiologist's fee accounted for 34% of the total; medical/surgical supplies, 20%; operating theater time, 17%; pharmacy, 7%; radiology, 5%; laboratory, 7%; and ward, 4%. Areas were identified in the latter 6 categories for change. Review of practice 1 year after implementation of the changes showed that a large number of recommendations were in place. We describe a new method for auditing the processes of medical care, using the itemized bill to adapt and use information primarily recorded for financial purposes.

Cholecystectomy, Laparoscopic↗