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Case Reports
. 2005 Jun 7;11(21):3311-4.
doi: 10.3748/wjg.v11.i21.3311.

Hand-assisted laparoscopic surgery for complex gallstone disease: a report of five cases

Qi Wei  1 , Lai-Gen Shen, He-Ming Zheng
Affiliations
Case Reports

Hand-assisted laparoscopic surgery for complex gallstone disease: a report of five cases

Qi Wei et al. World J Gastroenterol. .

Abstract

Aim: To describe the use of hand-assisted laparoscopic surgery (HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS.

Methods: Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecystectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached.

Results: HALS was performed on three patients with MS type I and 2 with mimic MS owing to an unclear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection.

Conclusion: HALS for MS type I and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.

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Figures

Figure 1
Figure 1
Position of the Trocars and the hand. A: Camera port; B: working port; C: hand insertion; D: additional port.
Figure 2
Figure 2
Preoperative MRCP demonstrated compression of the CHD by a large stone with dilation of intrahepatic bile duct characteristic of Mirizzi’s syndrome (Case 4).
Figure 3
Figure 3
Causes of hand-assisted laparoscopic surgery. A: One 1.0-cm stone impacted in the infundibulum fused with the CHD, impossible to remove with laparoscopic instruments; B: Using the intra-abdominal hand to facilitate such maneuvers as squeezing out of the stone (case 1); C: Compression of the CHD by one 2.5-cm stone; D: Identification and dissection of the obscured Calot triangle by the hand (case 4); E: A severely inflamed gallbladder with a neck stone caused obscured Calot’ triangle without jaundice (mimic Mirizzi syndrome, case 2).
See this image and copyright information in PMC

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