Jeffrey Albright, MD
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.