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ORIGINAL ARTICLE
Ten-point Strategy for Safe Laparoscopic Cholecystectomy:

A Prospective Study

1
Ashok K Yadav , Jeevan Kankaria 2

AbstrAct
Aims/objectives: To devise a 10-point strategy for performing safe laparoscopic cholecystectomy (LC), share experience of 8,000 patients
without any conversion to open procedure by adopting the strategy, and assess its effectiveness.
Materials and methods: A total of 8,000 patients were prospectively analyzed during 2007 to 2017. A point was assigned to a specific finding
intraoperatively. Patients were divided into three groups based on the points. Anatomical variations, time of surgery, intraoperative/postoperative
complications were plotted for three groups, and statistical significance was calculated.
Results: In this study, 63.5% of patients were female. No case of conversion to open cholecystectomy (OC) was found. The youngest and oldest
patients were 2 and 109 years old, respectively. Mortality, negligible morbidity, or significant complications were not observed. Group I (1–4
points) had high-risk patients, and lowest safety, and group III (8–10 points) had low-risk patients, and highest safety, and group II (5–7 points)
had with equivocal numbers.
Conclusion: Laparoscopic cholecystectomy was performed keeping these 10 points in mind with patience and precautions. Chances of
conversion to open surgery can be reduced to zero, with minimal complications. The study suggests that in case of difficult anatomy, go gentle
and slow to safeguard from injuries.
Keywords: Cholelithiasis, Conversion to open, Gallbladder stones, Laparoscopic cholecystectomy.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1402

IntroductIon 1,2 Department of Surgery, SMS Hospital, Jaipur, Rajasthan, India
Gallbladder (GB) diseases are few of the commonest biliary Corresponding Author: Ashok K Yadav, Department of Surgery, SMS
1,2
tract diseases and surgical conditions requiring intervention Hospital, Jaipur, Rajasthan, India, Phone: +91 9549079488, e-mail:
3,4
worldwide. Laparoscopic cholecystectomy (LC) was introduced ashok.yadavmd@gmail.com
nearly 3 decades ago, and since then, it has become the gold How to cite this article: Yadav AK, Kankaria J. Ten-point Strategy for
5,6
standard; nearly 90% cholecystectomies are laparoscopically Safe Laparoscopic Cholecystectomy: A Prospective Study. World J Lap
7,8
performed. Patient- or surgeon-related multiple factors Surg 2020;13(2):55–60.
can lead to various complications and conversion to open Source of support: Nil

cholecystectomy (OC). 4,9,10 An OC is often performed for patients Conflict of interest: None
with GB mass or suspicion of GB malignancy, late third trimester
of pregnancy, previous upper abdominal surgeries, >60 years
of age, male sex, diabetes, history of endoscopic retrograde laparoscopic cholecystectomies are performed per week. Approval
cholangiopancreatography, dilated common bile duct (CBD), and was obtained from Institutional Ethical Committee before initiating
GB status; it is also performed when the laparoscopic approach the study.
fails. 7,11,12 Despite the experience, complication rates are higher Most of the patients were admitted for elective procedure.
with LC than OC, but those with OC are increasing due to decreased Patients with symptoms of acute cholecystitis were either operated
exposer to open procedure. 7,8,13,14 within 2–3 days of presentation or 6 weeks after the resolution of
During laparoscopic procedure, complication rates can be symptoms. Detailed history of the onset of symptoms, duration,
reduced with proper care and caution. 11,15 As a surgeon’s experience and progression was obtained. Patients were subjected to routine
increases, complication and conversion rates decrease. 11,16 blood tests, including complete blood count, liver function test,
This study aimed to share the experience of surgeons while kidney function test, serum electrolytes, HIV, HBSAg, HCV, bleeding
performing safe LC and points to consider in order to decrease time, clotting time, prothrombin time, and the international
complication and conversion rates. normalized ratio. Serum amylase and lipase were evaluated
MAterIAls And Methods to rule out pancreatitis, and serum alkaline phosphatase was
evaluated to rule our biliary obstruction. Imaging studies, such as
This is a prospective study of LC performed in 8,000 patients by a ultrasonography (USG), were performed. In some doubtful cases,
chief surgeon and under his supervision during 2007 to 2017 at SMS magnetic resonance cholangiopancreatography (MRCP) and
hospital, Jaipur, India. The SMS hospital’s surgical center performs computed tomography scans were performed to look for other
cholecystectomy using laparoscopy, except for few special cases pathology. Those detected with CBD stones in USG were subjected
where OC is beneficial. The center has eight surgical units, and to MRCP and endoscopic retrograde cholangiopancreaticography
the study was conducted by one unit only. In this unit, nearly 15 (ERCP) for stone clearance and operated after 6 weeks.

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