Faculty Bibliography

An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications are discussed. The authors conclude that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

We describe the successful laparoscopic removal of a distal ureteral cystine stone not amenable to ureteroscopic or medical therapy. This approach offers an alternative to open ureterolithotomy in patients when less invasive measures fail.

During a 5-month period in the intensive care unit of a tertiary-care hospital, an outbreak of Acinetobacter calcoaceticus var. anitratus occurred. Of 51 patients with positive cultures, 24 died. Procedural analysis revealed that some health care workers had failed to wash their hands adequately, and to use latex gloves correctly. Environmental cultures taken during the outbreak revealed 3 sources for A. calcoaceticus, which can survive on inanimate objects for several weeks and is spread through cross-contamination. While common patient risk factors were identified, including ventilator support, IV antibiotics, prior surgical procedures or instrumentation, and chronic medical disease, the outbreak underscores the need for adherence by medical personnel to aseptic techniques.

Laparoscopic pelvic lymphadenectomy has been found to be efficacious in the staging of genitourinary cancers. Technological advances in endoscopic instrumentation have allowed an extraperitoneal approach to be performed. Presented are two patients who underwent an extraperitoneal endoscopic lymph node dissection as a staging procedure for prostatic carcinoma. Technical aspects of the procedure and advantages relative to the laparoscopic intraperitoneal approach are discussed.

Laparoscopic cholecystectomy removes the gallbladder through three or four puncture wounds in the abdominal wall. The technique reduces the recuperative time to full activity, from as long as 4 wk to as little as 3 days, compared with conventional cholecystectomy. We herein present our initial experience with this procedure. In this series of 111 laparoscopic cholecystectomies, there were no mortalities and only one morbidity. Thirty-nine patients (35%) had a history of prior abdominal surgery. Fourteen underwent laparoscopic lysis of adhesions. Intraoperative cholangiograms were performed in 24 patients (21%), demonstrating choledocholithiasis in three. Two of the three patients underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP); in the other, laparoscopic common bile duct exploration was performed. In each case, the common bile duct (CBD) was completely cleared of stones. Incidental laparoscopic appendectomy was also performed in three patients. The average time for completion of laparoscopic cholecystectomy in cases of chronic cholecystitis was 40 min. If the gallbladder was acutely inflamed, the procedure took a mean of 126 min. This series had a higher percentage of patients (19%) with acute cholecystitis then previously reported; therefore, the 2% conversion rate in this series emphasizes the broad applicability of the technique. The average length of stay in the hospital was 1.4 days, and patients returned to work in about 7 days.