The development of laparoscopic technology in light of cholecystectomies performed between 1993 and 2007

Introduction: The spread of laparoscopia has required surgeons to familiarize with a completely new surgical method and by today this method has clearly become of major importance in gastrointestinal surgery. The evolution of laparoscopic cholecystectomy offers many good lessons to learn for the purposes of advanced laparoscopic surgeries and surgeons may benefit from this experience in any process of introducing new minimal invasive techniques.

Methods and Material: We have made a retrospective analysis of the data of the cholecystectomies made right after laparoscopia had become a widely spread, routine surgical method (1993) as well as 14 years later (2007). The data have been processed using the SPSS 16.0 application package. Significance levels have been established with the chi-square probe.

Results: Within the analised timeframe we could clearly see a growing use of laparoscopic techniques (52,09% vs. 90,13%) with a growing number of cases (263/304), unchanged average age (53,5 years) and constant male/female ratio (75/25%). The BMI increased moderately (26,5 vs. 27,6), but the frequency of laparoscopic interventions on extremely obese patients grew (BMI:25–30:25,5% vs. 33%, 30–35:10,6% vs. 16%, 35–40:2% vs. 4,2%) while the postoperative hospitalization decreased dramatically from 5,9 days to 2,3. In 1993 patients spent on the average 2,9 days in hospital after a laparoscopic surgery, as long as in 2007 nearly 25% of the patients left the hospital 1 day after surgery. The duration of a laparoscopic surgery decreased from 78 minutes to 53, and the occurrence of intraoperative complications also decreased. The conversion ratio increased from 2,7% to 4,9%. In 3% of the laparoscopic cholecystectomies only 3 ports were used.

Discussion: As surgeons have come to master the new technique, the previous relative and absolute pros and cons have been revised and at present 90% of cholecystectomies are made using laparoscopia. The data collected in the analysis of laparoscopic techniques can be used to research, learn and eventually introduce NOTES.