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Ten-point Strategy for Safe Laparoscopic Cholecystectomy
Table 5: Anatomic variation
2
χ test with 2°
Variation Group I (1–4) Group II (5–7) Group III (8–10) of freedom p value
No adhesions 0 160 3216 885.483 0.0000 (s)
Minimal adhesions 160 330 992 211.961 0.000 (s)
Dense adhesions 400 320 80 3390.843 0.000 (s)
Calot’s triangle obliterated 320 240 160 1888.098 0.000 (s)
Contracted GB 280 200 160 1637.966 0.000 (s)
Mucocele 80 240 440 253.480 0.000 (s)
Free floating GB 0 320 320 83.333 0.000 (s)

Fig. 1: Showing anatomic variation
Table 6: Duration of surgery
2
χ test with 2°
Duration Group I (1–4) Group II (5–7) Group III (8–10) of freedom p value
<45 minutes 0 160 5,200 2977.907 0.000 (S)
45–90 minutes 160 640 1,200 877.656 0.000 (S)
>90 minutes 400 240 0 3938.844 0.000 (S)

The timing of surgery was evaluated to know which group surgeries in group III were performed within stipulated time of
needed more time for safe surgery (Table 6 and Fig. 2). 45 minutes.
Intraoperative complications were evaluated in the three Analyzing the complication rates in all the three groups showed
groups as shown in Table 7. that group I had maximum number of cases with complications
This ten-point strategy was followed in all the surgeries. So, in and group III had the least number of complications, whereas
cases of difficult anatomy, the surgeon slowly and gently performed group II was in-between. This shows that if LC is performed
the surgery to properly delineate the anatomy. These 10 points can considering the aforementioned steps and the 10-point strategy,
be followed, and injuries can be safeguarded. the surgery would be safe. Also, as the points go up, the chances
Comparing the three groups, maximum number of patients of safe surgery go up (Table 8).
with complicated anatomy were present in group I followed by
group II, whereas group III included most patients with simple
anatomy. Group I needed more time to perform the surgery dIscussIon
safely because of the presence of complicated anatomy; in this The present study shows the author’s experience as a chief surgeon
case, group I was followed by group II. Maximum number of performing LC, in a teaching hospital, over a period of 10 years.

World Journal of Laparoscopic Surgery, Volume 13 Issue 2 (May–August 2020) 57