1993 Volume 42 Pages 138-142
The laparoscopic cholecystectomy has the advantage of minimal invasion as well as high cosmetic acceptability due to the extremely small incisions required. However, there is no guarantee that all cases can be treated successfully with this new modality. A few cases are unfortunately converted from laparoscopic to conventional open cholecystectomy because of intractable severe adhesion or unexpected complications.
In our experience of 500 cases (including combined common bile duct stones, liver cirrhosis, acute cholecystitis, and history of upper abdominal surgery) , 3 were converted to conventional open surgery. One was due to bleeding encountered with the patient identified as Case No 1, which would surely be avoidable at the present that abundant experience has been accumulated. The others were due to severe adhesions encountered with the patients identified as Case No 46 and No 302, which is considered to have been a reasonable and justifiable decision.
The safety and efficacy of this new procedure seem to have been unanimously confirmed, although there still remain some minor controversies as to technical aspects of the procedure.
Judging from our results, the rates of conversion from laparoscopic to conventional open cholecystectomy should be kept to less than 1 percent at least, and we considered a new modality laparoscopic cholecystectomy as an alternative to open cholecystectomy. But the prerequisite conditions for this new procedure to replace conventional open cholecystectomy is its safety.
In laparoscopic cholecystectomy, there is an apparent learning experience which is covered only by adequate training and experience. With less experienced operators, the threshold of indication for laparoscopic cholecystectomy should be set high in order to secure the safety of the patients as well as the successful completion of the procedures.
At present in Japan, this modality of laparoscopic cholecystectomy is replacing conventional open cholecystectomy owing to its advantage of quality of life (QOL) for patients.
