Cholecystectomy is the most
common surgical procedure done by general surgeons accounting for one-third of
all surgical emergency hospital admissions (1). Indications for cholecystectomy
are cholecystitis, cholelithiasis, choledocholithiasis, gallbladder
calcification, biliary colic, biliary pancreatitis, and gallbladder cancer. Gallstones
are present in 10% of the world population, with 20% of those people being
symptomatic, of which 1-3% will develop acute cholecystitis (2). That is
roughly .2% of the population of the world. Patients presenting with acute
cholecystitis should have a cholecystectomy performed within 23-48 hours (3).
Current Available Approaches:
Cholecystectomy is a
relatively safe procedure, and much safer today than previously due to the
advent of minimally invasive surgery. Laparoscopic cholecystectomy procedures
have been shown to be safe, and result in fewer complications and shorter hospital
stays when compared to open laparoscopic cholecystectomy (4). Likewise, incidences
of pneumonia and wound infection are reduced with a laparoscopic approach (5).
Limitations of Current Approaches:
Many medical advances have
occurred to reduce the likelihood or perforating bowel or causing vascular
injury such as the advent of visual
entry, Veress needles, and radially expanding trocars. However, none of the
tools can completely remove the chance for laparoscopic injury from entry (6).
Furthermore, there are common post-op complications from laparoscopic
incisions. It has also been shown that the incidence of incisional site hernias
from laparoscopic procedures is around 1.9% and 3.2% at 2 and 5 years. Although
this is greatly reduced from open at 8 and 12% respectively, it is still a
significant contributor to post op morbidity (7).
Scientific Rational of New Surgical Approach:
The Levita magnetic surgery
system has already received clearance from the FDA. It works by using a magnet
grasper to grab the gallbladder, detaching the tip from the grasper and using
an external magnet to lift the gallbladder into position for dissection. The magnet
can be moved externally to adjust the position of the gallbladder, limiting the
necessity of an additional incisions and instrumentation insertion. This new
procedure can help reduce the total number of trocars use in laparoscopic
procedures, potentially reducing the risk for trocar placement complications (8).
Complications that may be reduced due to magnetic surgery may include
infections, bowel perforation, vascular injuries, scarring at excessive
incision sites, hernias, and pain at excessive incision sites (9).
Overall Relevance and Patient Impact
cholecystectomies are done each year and a rate of bowel or vascular
complication upon initial trocar placement of 1.1/1000 (9), a reduction in the
number of trocars being place could significantly cut done on operation
complications. This technology can be adapted to use in multiple other
abdominal surgeries, providing not only few trocar placements, but also better
visualization of relevant anatomy. Few incisions and better visualization in minimally
invasive procedures will make for fewer post-op complications, easier intraoperative
visualization of anatomy and overall better outcomes for patients.