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Related Experiment Videos

Clipless laparoscopic cholecystectomy--a prospective observational study.

J N Shah1, S B Maharjan

  • 1Department of Surgery, Patan Hospital, Patan Academy of Health Science, Lalitpur, Kathmandu, Nepal. drjaywufei@gmail.com

Nepal Medical College Journal : NMCJ
|January 13, 2011
PubMed
Summary
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This study introduces a simple, safe, and economical intracorporeal single ligation of the cystic artery and duct (SLAD) technique for laparoscopic cholecystectomy. This method avoids costly clips and reduces operative time, proving effective in preventing complications.

Area of Science:

  • Minimally Invasive Surgery
  • Surgical Techniques
  • Gastrointestinal Surgery

Background:

  • Laparoscopic cholecystectomy (LC) traditionally uses titanium clips for cystic duct and artery, which can be time-consuming and costly.
  • Alternative methods like harmonic scalpels or LigaSure are often prohibitively expensive for resource-limited settings.
  • Existing intracorporeal ligation techniques often involve multiple ligations, increasing operative complexity.

Purpose of the Study:

  • To evaluate the safety, efficacy, and economic viability of a modified intracorporeal single ligation of the cystic artery and duct (SLAD) technique in laparoscopic cholecystectomy.
  • To present a cost-effective alternative to titanium clips and expensive energy devices for LC in resource-limited environments.
  • To assess the operative time and complication rates associated with the SLAD technique.

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Main Methods:

  • A modified intracorporeal single ligation of the cystic artery and duct (SLAD) using free silk 2/0 ties was developed and piloted.
  • The technique was applied to 80 patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis between July and October 2009.
  • Data on operative time, complications, and patient demographics were collected and analyzed.

Main Results:

  • The SLAD technique was successfully implemented in all 80 patients with no bile leaks or ligature-related complications.
  • The average time for performing the single ligation was 3 minutes (range 2-7 minutes).
  • Complications were minimal, with only two cases of umbilical port inflammation, and no increase in overall operative time was observed.

Conclusions:

  • Intracorporeal single ligation of the cystic artery and duct (SLAD) is a simple, safe, and economical technique for laparoscopic cholecystectomy.
  • This no-clip laparoscopic cholecystectomy (NCLC) approach eliminates clip-related complications and is suitable for resource-limited settings.
  • The SLAD technique does not prolong operative time and offers a cost-effective alternative for managing symptomatic cholelithiasis.