[Technical difficulties of microlaparotomy for cholecystectomy]

Microlaparotomy cholecystectomy (MLC) is an alternative for minimal invasive surgical interventions of the biliary tract. In Hungary over 7000 operations were performed in 21 surgical departments as at December 31. 1998 and numerous additional departments have indicated their demand for the initiation of the method. Every new surgical procedure requires a "learning curve" during the application of MLC, difficulties encountered with the surgical solution occurred in a 14-15% range. We studied difficulties noticed during micro-, minilaparotomy cholecystectomy in 2400 unselected cases from the adoption of the surgical method in our department until December 31, 1998. We grouped our findings into avoidable, and unavoidable difficulties. Circumstances that can present unavoidable difficulties include: the patient's abnormal change in build, surgical interventions that have to be performed on patients 8-10 days after obstructive cholecystitis, abnormal gallbladder not indicated during preoperative examination, as well as biliary tract variations. A considerable part of the difficulties can be avoided by MLC-desirable positioning of the patient on the operating table, appropriate choice of surgical incision site and method, satisfactory anaesthesia, the use of necessary instruments suitable for exposure and unobjectionable illumination of the surgical area, as well as the performance of cholecystectomy with required modifications per given circumstances. The concomitant 2.5-16% alternating conversion rate after minicholecystectomy is indicative of the importance of the use of instruments assuring adequate exposure and excellent illumination of the surgical area. During the practice in our department this occurrence was recorded in 0.29% with the use of the ROMICRO R-set.