From inside out. Microperforation of the gallbladder during laparoscopic surgery may liberate mucosal cells

Abstract

Background: Port-side recurrence after laparoscopic surgery on known and unsuspected gastrointestinal malignancies has been reported. The mechanisms of this type of metastatic spread are poorly understood. For in situ malignancies, microperforation of the viscus by laparoscopic instruments may liberate cells to facilitate malignant cell movement.

Methods: Twenty-three patients undergoing laparoscopic cholecystectomy for benign disease were prospectively studied. The laparoscopic fundal grasper was washed with sterile saline at the start and conclusion of surgery. These washings were examined for the presence of mucosal cells as evidence that gallbladder perforation occurred during the operation.

Results: No mucosal cells were seen from washings at the start of surgery. Thirteen cases (56%) of perforation or attempted choledochogram were recorded during surgery. Four of these 13 washings contained mucosal cells. One washing was positive for mucosal cells in the absence of perforation or attempted choledochogram.

Conclusions: Microperforation of the gallbladder by laparoscopic instruments occurs during laparoscopic cholecystectomy.