It is estimated that over 20 million Americans have
cholelithiasis, or the presence of gallstones. In addition, individuals with
biliary dyskinesia, a condition that results in chronic cholecystitis unrelated
to gallstones, accounts for a small but significant proportion of gallbladder
disease. Over 500,000 cholecystectomies are performed annually in the US.
People with gallbladder disease often present with
characteristic descriptions of their attacks. Most commonly, pain is
experienced in the right upper quadrant and epigastrium and may radiate to the
back or shoulder. Pain is often associated with nausea and vomiting, and
generally occurs after eating a fatty meal.
Those with symptomatic cholelithiasis experience self-limited episodes
of colicky pain resulting from transient cystic duct obstruction.
When acute cholecystitis develops from persistent cystic
duct obstruction, the presentation is often more dramatic and prolonged,
sometimes for days at a time. Such patients often visit their primary care
physician or seek urgent/emergency care. At this point, gallbladder disease
must be differentiated from other common conditions like peptic ulcer disease,
gastritis, pancreatitis and dyspepsia.
The number of cholecystectomies has increased significantly,
since the advent of laparoscopy in the early 1990’s. Prior to the laparoscopic
approach, gallbladder surgery required a large incision, several days of
inpatient recovery and painful convalescence. Since the laparoscopic era, gallbladder
surgery has changed to an outpatient procedure with significantly less pain and
recovery time. Further, patients generally have only a few incisions, with the
largest being about an inch long. The era of laparoscopy has been
transformative from the perspective of decreasing patient suffering and
hospital length of stay.
Recently, surgeons have begun to adopt a new tool in their armamentarium
for treating gallbladder disease. Through advances in the technology of
surgical robots, such as the da Vinci system, the multi-incision approach to
cholecystectomy is being challenged. Using a single, one inch incision within
the umbilicus, the same procedure can be performed with better cosmetic
results. The high definition three-dimensional visualization available on
robotic systems (not in traditional laparoscopy), allows surgeons to see a
patient’s anatomy in unprecedented detail. This advancement has the potential
to improve patient safety through enhanced visualization, not to mention the
cosmetic benefits of hidden scar tissue.
Dr. Jeffrey
Albright is
a board-certified general
and colorectal surgeon with Brookwood Medical Center.
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