Abstract
Laparoscopic cholecystectomy was attempted in 100 patients from February 1991 to November 1992. Fifty-eight patients of them were performed at 15 associated hospitals as training procedures for 15 general surgeons. Seven patients required conversion to a conventional open cholecystectomy due to dense adhesions surrounding the gallbladder in three patients, fallen gall stones in the peritoneal cavity in two, hemorrhage from the cystic artery in one, and unsuspected gallbladder neoplasma in one. There were two major complications: clip ligation of the right hepatic artery in one patient with acute cholecystitis and moderate ascites accumulation in one patient with Child B class liver cirrhosis. Surgeons with general surgical experience of more than 10 years (average=14.0 years) at small and rural hospitals could perform safely laparoscopic cholecystectomy after more than three sessions (average=4.0 sessions) of training. There were two major complications associated with creation of the initial pneumoperitoneum. In order to prevent such complications, the open laparoscopy method should be recommended. As laparoscopic cholecystectomy appears to be a safe and effective treatment for selected patients with benign gallbladder diseases, as experienced general surgeon should make an attempt to learn this new technique.
