Rapid recovery + single or triple laparoscopic cholecystectomy

  Laparoscopic cholecystectomy (Lc) has become the “gold standard” for the treatment of benign gallbladder lesions because of its light trauma, low impact on the body’s internal environment, mild postoperative pain, rapid return to normal activities, and aesthetic appearance. With the increasing maturity of LC technology, the scope of application of LC is also expanding. According to the technical characteristics of LC, some foreign medical centers started to explore the feasibility and safety of outpatient laparoscopic cholecystectomy in the early 1990s and achieved good results. in the late 1990s, Kehlet et al. proposed the concept of accelerated rehabilitation surgical treatment and recommended a series of measures and techniques to speed up the recovery of patients after surgery, among which minimally invasive techniques are one of the important elements.  Based on this concept, we performed rapid recovery + single- or three-hole laparoscopic cholecystectomy, which significantly reduced the patient’s recovery time and surgical discomfort while ensuring safety. Preoperative gastric and urinary catheters are routinely not placed. Preoperative tests include routine urine and stool, routine blood, liver and kidney function, coagulation function, infectious diseases and other laboratory tests such as chest X-ray, electrocardiogram, hepatobiliary and pancreatic ultrasound. Some patients may also require preoperative endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) to rule out the possibility of bile duct stones within and outside the liver. Intraoperatively, a 1- or 3-hole Lc technique is used depending on the patient’s condition, with an additional hole for particularly difficult cases (traditional 4-hole method). A low-pressure pneumoperitoneum was used as much as possible. The operative field is carefully inspected before the end of surgery to stop bleeding thoroughly and to confirm that there is no blood leakage or bile leakage. No abdominal drainage tube is placed without special circumstances. The skin of the surgical incision can be closed with intradermal sutures or bio-glue application, without having to return to the hospital for stitch removal.  Advantages include: (1) Significantly shortens the hospital waiting time and treatment time for LC surgery, effectively increasing hospital bed turnover and enabling more patients who need treatment to receive timely treatment. (2) Significantly reduce patient discomfort in the hospital and the chance of hospital-acquired infections and other related complications, better reflecting the concept of human-centered treatment. (3) Reduces medical costs to a certain extent. (4) Implementing the medical concept of rapid recovery, the patient suffers less perioperative pain, recovers quickly after surgery, and can return to normal work and living environment sooner.