Abstract
Laparoscopic cholecystectomy has been popularized as a minimally invasive surgery for benign gallbladder disease. The purpose of this report is to introduce our initial experience and to clarify the efficacy of the laparoscopic cholecystectomy using Nd: YAG laser. Since October 1990, 55 cases were treated by laparoscopic cholecystectomy. The indication of this procedure was cholecystolithiasis in 52 cases and gallbladder polyp in 3 cases. Our procedures were summarized as follows: pneumoperitoneum by CO2 gas insufflation, four-trocar-technique, keeping the laparoscope with the operator's left hand, separately clipping the cystic duct and the cystic artery, and dissection of the gallbladder from the liver bed by Nd:YAG laser. Contact laser was applied with a saphire tip connected to quartz fiber or directly from a soft touch fiber. Contact Nd: YAG laser was useful for dissecting sharply thick tissue of the gallbladder wall due to chronic cholecystitis, and also for hemostasis with coagulation. Total volume of the laser energy was averaged 2312J in 41 cases. As a minor complication injury of the gallbladder body was caused by laser scalpel in 13 cases, and bleeding from the serosa or the liver bed occurred in 12 cases. However no case has been required major laparotomy for the reason of the laser injury. We conclude that laser is an effective benefactor to challenge the minimally invasive therapeutics.
