Diego L Lima, MD, Gildo O Passos Junior, MD, Juscielle S Barros, Ingrid L V. Rodrigues, Yukie C Konishi, Frederico W C. Silva, MD, Gustavo L Carvalho, PhD. University of Pernambuco, Faculty of Medical Sciences.
INTRODUCTION – Historically, the rate of bile duct injury (BDI) in the era of open cholecystectomy was approximately 0.2%. In the laparoscopic era BDI increased and reached a plateau of 0.4%. A recent review of 45 papers showed an increase in BDI rate with single incision laparoscopic cholecystectomy (SILC) to 0.72%. The aim of this study is to calculate the rate of BDI during minilaparoscopic cholecystectomy (MLC) and compare this rate to the accepted historic rate for open cholecystectomy, standard laparoscopic cholecystectomy and SILC.
METHODS AND PROCEDURES – A comprehensive database search of MEDLINE and PubMed Central was performed to generate all relevant work with minilaparoscopic cholecystectomy to present. The following key-words were used: “minilaparoscopic”, “needlescopic”, “microlaparoscopic” and “cholecystectomy”. The research was limited to reports of 25 or more patients based on current literature of existing MLC learning curves.
RESULTS – A total of 16 original published reports were selected, covering the period 1999-2011. In aggregate, 3131 patients underwent MLC. The overall complication rate was 0.48%, including leaks, BDI, conversion and death. A similar review found 4,2% as aggregate complication rate in similar cases of SILC. Referring specifically to the BDI, the rate was approximately 0.10% (3 in 3131 cases of MLC).
CONCLUSION – Relevant studies on MLC have shown that BDI rate is lower when compared to traditional laparoscopic surgery, SILC or even open technique. The results indicate that minilaparoscopy with its increased visualization and delicacy may help to avoid BDI, when performed by a experienced surgical team.