Longitudinal cholecystectomy study: patterns of care in a total community experience.

The purpose of this study was to determine outcomes and safety of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) in a community setting at multiple open staff hospitals with multiple surgeons. This second-year study retrospectively examined all cholecystectomy records in one city at each of five hospitals over a 1-year period beginning in April 1991 through March 1992. All charts were examined for type of surgery, rate of conversion to open procedure, sex, weight, previous abdominal surgery, surgeon, hospital, preoperative workup, operative time, antibiotic prophylaxis, cholangiograms, concurrent procedures, drains, hospital stay, common duct stones and their follow-up, pathology, reoperations, complications, and mortality. One thousand eight hundred one gallbladders were removed. One thousand three hundred four (72.4%) were successfully removed at LC. One hundred eighty-three (10.2%) others were attempted laparoscopically and converted to open cholecystectomy (CC), which represented 12.3% of the attempted LCs. Three hundred fourteen (17.4%) were removed via a standard OC. The mean operative times were 72.3 minutes for LC, 100.1 minutes for CC, and 86.2 minutes for OC. Cholangiography was attempted in 916 (70.3%) LCs, 144 (78.7%) CCs, and 250 (79.6%) OCs, with similar operative times, except in LC, when done via the GB, operative time was 65.2 versus 73.4 minutes when done via the cystic duct. Diagnosis of acute cholecystitis occurred in 306 (23.5%) LCs, 119 (65.0%) CCs, and 145 (46.2%) OCs. Complications requiring reoperation occurred in 30 (2.3%) LCs, 5 (2.7%) CCs, and 5 (1.6%) OCs. Common bile duct (CBD) injuries occurred in 5 (34%) LCs, with 4 converted to CC and 1 repaired 5 days later. Trocar site hernias occurred in 11 (0.8%) LCs. Thirty-nine surgeons participated in the study with mean numbers of 33.4 LC cases, 5.5 CC cases, and 7.2 OC cases, with ranges of 1 to 165 LC cases, 1 to 17 CC cases, and 1 to 24 OC cases. Death occurred in 12 (0.9%) LC cases, 4 (2.2%) CC cases, and 25 (8.0%) OC cases. The mean hospital stay was 39.6 hours for LC, 156.5 hours for CC, and 198.3 hours for OC.

Thermal profiles of electrocauteries, the Nd:YAG laser, and the electromagnetic-field focusing system.

Electromagnetic-field focusing (EFF) is a method of converging induced eddy current onto a pointed tip of a tuned length return circuit in the near field of a resonator, which results in the production of high temperature. Previously reported applications of this method include various devices for local hyperthermia and a precision surgical device. The latter is currently being used in human clinical trials under two investigational device exemptions from the Food and Drug Administration. In the present work, the thermal profile produced in a uniform, tissue-simulating phantom by the hand-held probe of the surgical EFF system is compared with those produced by mono- and bipolar electrocauteries and by a contact Nd:YAG laser. At the equivalent power setting and 2-cm insertion depth, the EFF probe was shown to have a tighter thermal profile than the monopolar electrocautery or the contact Nd:YAG laser. This finding is consistent with earlier histologic evidence that brain cortical tissue cut by the surgical EFF probe had minimal thermal damage in the tissue surrounding the incision.