In the past, removal of the gallbladder was advocated for both gallbladder stones and gallbladder polyps, believing that the gallbladder has no important function and is dispensable, and it is no longer possible to recur gallbladder stones or gallbladder polyps if the gallbladder is removed, so removal of the gallbladder is gradually considered to be the most ideal treatment for gallbladder stones and gallbladder polyps. However, removal of the gallbladder can cause a series of adverse consequences in a significant number of patients, which not only severely traumatize the digestive system, but also affect the immune system and endocrine system. The new endoscopic biliary surgery is the true manifestation of minimally invasive.
In the past, the concept of minimally invasive surgery only emphasized small incision, short operation time, little tissue damage and fast recovery. However, with the metamorphosis of the minimally invasive concept, the minimally invasive concept now places more emphasis on preserving the function of a healthy organ.
The important physiological functions of the gallbladder, such as: 1. storage function; 2. contraction function; 3. concentration function; 4. secretion function; 5. immune function; 6. important influence on digestive function; 7. important regulation of bile duct fluid pressure, etc., are gradually gaining people’s attention.
Minimally invasive fiberoptic choledochoscopic lithotripsy preserves millions of functional healthy gallbladders, avoids heavy trauma to the digestive system, has no serious postoperative complications, and causes little trauma to the digestive system, immune system, and endocrine system. Only a small incision is made at the base of the gallbladder, which is all the trauma to the digestive system. Moreover, the adverse effects on the immune system and endocrine system are not obvious. Recent studies have concluded that immunosuppression caused by surgical trauma is an important cause of the increased chance of postoperative infection and tumor metastasis. Changes in the immune function status of the body after surgery are associated with the abnormal release of cytokines after the blow of surgery. The greater the surgical trauma, the greater the negative impact due to abnormal release of cytokines after surgery. Relevant studies have proved that the changes in immune function after trauma and surgery in the organism due to insufficient preoperative psychological preparation, pneumoperitoneum, and surgical injury are manifested by changes in cellular and humoral immunity, among which changes in lymphocytes are predominant. A comparison of the above-mentioned response levels and a study of some endocrine hormones showed that laparoscopic surgery is significantly less damaging to the immune system than open surgery. In addition, the same results were obtained in experiments on the endocrine system for the same scientific purposes. In other words, laparoscopic surgery is much less traumatic than open surgery on all systems of the body.
New concept of minimally invasive fiberoptic choledochoscopy for biliary stone extraction
Minimally invasive fiberoptic choledochoscopic biliary lithotripsy is a new concept of biliary lithotripsy, which can solve the problems of incomplete extraction of stones and the smoothness of the cystic duct after lithotripsy, by strictly ensuring the basic indications of the operation and adequate preoperative preparation.
The advantages of minimally invasive fiberoptic choledochoscopy
Highlight 1: Minimally invasive
This advanced technology only requires 3 (about 0.5-2cm) micro-incisions in the patient’s abdominal wall to avoid leaving long scars in the patient’s abdomen, which is less invasive, less painful, safe and does not affect the beauty of the surgery; the procedure is visible and safe.
Highlight 2: Clear surgical field
With the help of high-tech products laparoscope and fiberoptic cholangioscope, the laparoscope is first inserted through abdominal puncture with a pneumoperitoneum needle to explore the location, appearance and whether there are adhesions of the gallbladder, and after confirming that the gallbladder is normal outside, a small incision of 2cm is made under the rib cage to enter the abdomen, traction of the gallbladder, an incision of about 0.5cm is made at the bottom of the gallbladder to insert the cholangioscope, and the bile in the gallbladder is aspirated with a negative pressure suction device, while saline is put in to flush the gallbladder cavity to make the field of view The choledochoscope can be used to remove the gallbladder stones under the direct vision of the fiberoptic choledochoscope.
Highlight 3: Complete stone extraction
The use of fiberoptic choledochoscope overcomes the blind spot of the old choledochostomy; the latest special stone retrieval net is used instead of the old stone retrieval forceps, which can avoid the small stones left in the gallbladder or abdominal cavity caused by the stone retrieval forceps, so that the stone retrieval is complete and no sequelae are left. Finally, the choledochoscope was used to repeatedly check the gallbladder cavity for small stones and to observe the flow of bile into the gallbladder in order to exclude stones from being embedded in the gallbladder duct. After determining that there are no stones in the gallbladder, the gallbladder is carefully sutured in two layers with absorbable thread, and the surgical incision is finally closed layer by layer.
Highlight 4: Fast recovery
As patients suffer minimal trauma, they can get down to the ground and eat 1 day after surgery, and can be discharged after 3-5 days of hospitalization, which does not affect normal work and life, and also reduces the cost of treatment.
Highlight 5: Low recurrence rate
After the stone extraction is completed, the choledochoscope can clearly observe whether the gallbladder duct is open, which is the key to avoid stone recurrence.
Which patients are suitable for choledocholithotomy
1, patients with gallstones whose gallbladder ducts are patent.
2, patients with gallstones whose gallbladder function is normal
3, patients with gallstones with mild inflammation of the gallbladder.
4.Patients with non-sedimentary stones, solitary stones or those who are considered to be eligible for the procedure by the physician who examined the number of stones.