Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders

21 Pages Posted: 12 Apr 2022

See all articles by Kayla Umemoto

Kayla Umemoto

California Northstate University College of Medicine; University of California, Berkeley

Shahini Ananth

California Northstate University College of Medicine

Anthony Ma

California Northstate University College of Medicine

Anvay Ullal

California Northstate University College of Medicine

Prakash Ramdass

St. George's University School of Medicine

Peter Lo

San Joaquin General Hospital

Dinesh Vyas

Adventist Dameron Hospital-CMO Quality; California Northstate University College of Medicine

Date Written: March 1, 2022

Abstract

Background: Laparoscopic cholecystectomies (LC) for gangrenous gallbladders (GGB) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retrospective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs.

Methods: in this retrospective study of 386 LCs, data was collected for patient demographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss (EBL), conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of 5 surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs (VC), and (4) non-Vyas group of 5 surgeons treating non-GGBs (NVC). Control groups were age and sex matched. Statistical analysis used descriptive statistics in addition to unpaired t-testing and chi-square testing (α=0.05).

Results: Unpaired t-testing demonstrated significantly decreased (p<0.05) OT, AT, and LOS between the VHG and NVG groups, with HD reducing OT by 51.4% compared to blunt dissection. Unpaired t-testing for EBL and chi-square testing for conversion to open procedures and 30-day readmissions did not demonstrate significantly decreased (p>0.05) values between the VHG and NVG groups. There were no mortalities.

Conclusion: HD improves surgical outcomes of LC for GGBs by reducing OT, AT, and LOS. Further studies are needed to validate HD implementation.

Note:
Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Interests: Kayla Umemoto reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Shahini Ananth reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Anthony Ma reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Anvay Ullal reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Ramdass reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Peter Lo reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Dinesh Vyas discloses that he is CEO and President MV Surgical LLC, MV Surgical Medical Technologies Inc., MV Surgical Medical Devices Inc. and Stocks in BlackSwan Inc.

Ethics Approval Statement: IRB of San Joaquin General Hospital gave ethical approval for this work with an approved waiver of informed consent. This was a retrospective study where patients were deidentified.

Keywords: Laparoscopic Cholecystectomy, Gangrenous Gallbladder, Hydrodissection

JEL Classification: I1

Suggested Citation

Umemoto, Kayla and Ananth, Shahini and Ma, Anthony and Ullal, Anvay and Ramdass, Prakash and Lo, Peter and Vyas, Dinesh, Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders (March 1, 2022). Available at SSRN: https://ssrn.com/abstract=4065017 or http://dx.doi.org/10.2139/ssrn.4065017

Kayla Umemoto

California Northstate University College of Medicine ( email )

9700 W Taron Dr
Elk Grove, CA 95757
United States

University of California, Berkeley ( email )

CA
United States

Shahini Ananth

California Northstate University College of Medicine ( email )

9700 W Taron Dr
Elk Grove, CA 95757
United States

Anthony Ma

California Northstate University College of Medicine ( email )

9700 W Taron Dr
Elk Grove, CA 95757
United States

Anvay Ullal

California Northstate University College of Medicine ( email )

9700 W Taron Dr
Elk Grove, CA 95757
United States

Prakash Ramdass

St. George's University School of Medicine ( email )

Grenada

Peter Lo

San Joaquin General Hospital ( email )

500 W Hospital Rd
French Camp, CA 95231
United States

Dinesh Vyas (Contact Author)

Adventist Dameron Hospital-CMO Quality ( email )

United States

California Northstate University College of Medicine ( email )

United States

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