Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model

Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Cistolitectomia e ressecção de cisto renal por laparoscopia em uma cadela com aderências intraperitoneais: relato de caso / Cystolithectomy and renal cyst resection by laparoscopic surgery in a female dog with intraperitoneal adhesions: case report

No presente relato descreve-se a remoção de urólitos vesicais, bem como o tratamento de um cisto renal por cirurgia laparoscópica em um cão com aderências intraperitoneais. Para o acesso foram utilizados três portais, dois de 10mm e um de 5mm, dispostos na linha média ventral e nas paredes abdominal direita e esquerda. Após a remoção das litíases, realizou-se sutura intracorpórea da parede vesical em duas camadas. O cisto renal direito foi drenado e sua cápsula extirpada. Ocorreu a perda temporária de um urólito na cavidade abdominal e sua posterior recuperação pela cirurgia laparoscópica. O paciente não apresentou recidiva da doença pelo período mínimo de 14 meses. A cirurgia laparoscópica mostrou-se eficaz na terapêutica de ambas as patologias, sem a necessidade de alteração do posicionamento dos portais.

This study reports the laparoscopic treatment of urolithys and renal cist in a dog with adherences after laparotomy. Three portals (two with 10mm and one with 5mm) were used in the middle ventral line or lateral flanks. The calculi were removed, and two intracorporeal sutures were made in the vesicle tissue. The right cystic tissue was drained and its capsule was extirpated. One calculus was lost in the peritoneal cavity, but later recovered by laparoscopy. The patient did not show urinary vesicle disease during at least 14 months. The laparoscopic cistotomy appears to be adequate to remove urolithys and to treat renal cystic disease in dogs.