Assessment of Degree of Difficulty in Laparoscopic Cholecystectomy using Intraoperative Scoring System PC11-PC14
Dr. Navin Kumar,
Assistant Professor, Department of Surgery, All India Institute of Medical Sciences,
Rishikesh-249203, Uttarakhand, India.
Introduction: Laparoscopic cholecystectomy is one of the most commonly performed minimally invasive surgery. But in every patient, there are different types of difficulties in performing laparoscopic cholecystectomy and outcome may be different according to the difficulties.
Aim: To assess and grade the degree of difficulty in laparoscopic cholecystectomy and their postoperative outcome using intraoperative scoring system devised.
Materials and Methods: One hundred three consecutive patients who underwent elective laparoscopic cholecystectomy at Himalayan Institute of Medical Sciences, were included in the study. Inclusion criteria was all the cases of elective laparoscopic cholecystectomy and exclusion criteria was cases in which directly open cholecystectomy was performed. Intraoperative findings were assessed on the basis of five key aspects which includes: 1) Gallbladder appearance and amount of adhesions; 2) Degree of distension/ contraction of the gallbladder; 3) Ease of access; 4) Local/septic complications; and 5) Time taken to identify the cystic artery and duct.
Results: Total 103 patients of laparoscopic cholecystectomy were included in this study. The severity score was between 2-4 in 63 (61.16%) patients and between 5-7 in 20 (19.41%) patients. Mild to moderate degree of difficulty was encountered in 80 (77.66%), severe degree in 20 (19.41%) and extreme degree of difficulty in 03 (2.91%) patients in performing cholecystectomy and conversion to open surgery were done in 08 (7.76%) patients with score between 6 to 8.
Conclusion: This scoring system is useful and reliable. If the intraoperative severity score is more, the severity of cholecystitis increases and then it is more difficult to perform laparoscopic cholecystectomy.