European Stars and Stripes (Newspaper) - August 21, 1990, Darmstadt, Hesse                                Standard procedure for removing a gallbladder called for an incision of 4-6 inches in the Abdomen. With the new laparoscopic technique Small holes Are Cut in the Abdomen through which a camera and surgical instruments Are inserted. A by Lawrence k. Altman new York times 3 thousands of surgeons Are learning a new technique for removing gallbladder that could greatly simplify the operations now performed on some 500,000 americans each year. The technique called laparoscopic cholecystectomy offers stunning health financial and cosmetic advantages Over the Standard operation surgeons say. Instead of cutting open the Abdomen to reach the gallbladder As is currently Standard procedure surgeons can now simply Cut several Small holes in the Abdomen through which they insert a camera and surgical instruments. Although the laparoscopic technique has been used by gynaecologists for Many years to diagnose and treat reproductive problems in women it is new to general surgeons. Its possible future applications May be limited Only by surgeons imaginations and the development of equipment. Some have already used the technique to perform appendectomy is and intestinal surgery. In the last two months surgeons at Washington University in St. Louis used the technique to remove a kidney in two patients. And surgeons elsewhere Are exploring the possibility of laparoscopic Chest surgery. But the technique is being applied most rapidly to remove gallbladder that have been inflamed by gallstones. The gallbladder is a Pear shaped Sac about four inches Long that stores bile that is made in the liver. After a meal the stored bile is released to Aid in digestion. Stones that commonly form in the gallbladder can cause severe inflammation. For unknown reasons gallstones Are More common among women than men. Small stones can pass out of the gallbladder to Block bile in the main bile duct causing the skin to yellow from jaundice stones in the bile duct can Lead to life threatening infections surgical removal of tie gallbladder and the gallstones is Standard therapy. A a Quot the procedure is spreading like wildfire through the country Quot said or Charles Mcsherry who does the laparoscopic procedure at Beth Israel it of ,. La it medical Center in new York. To new York City the other Day surgeons at the St. Luke s division of St. Luke a Roosevelt Hospital Center made four Small slits in a woman s Abdomen to insert a camera and then watched on a video screen As they manipulated the Long instruments through the holes to Cut out her gallbladder. A Little More than an hour later the diseased gallbladder and the dozens of Small stones contained in it slithered through her Navel. The Only scars were the puncture holes that were stitched and covered with Small bandages. After an overnight stay in the Hospital the woman went Home she was Back to her Normal activities within the week some such patients go Home the Day of the operation. The laparoscopic cholecystectomy enables such a rapid recovery because it avoids slicing the major Muscles of the Abdomen through the six Inch incision used in the operation that has been Standard for a Century. The older operation keeps a patient in the Hospital for up to a week and restricts physical activity for about six weeks while the major Muscles of the Abdomen heal. Many experts believe laparoscopic cholecystectomy will eventually replace the Standard operation for most of the 500,000 americans who have their gallstones and diseased gallbladder removed each year though the final word is not in. But medical experts Are concerned that too Many surgeons Are being trained too fast in courses that vary in length and Quality. Some courses last a Day others three Days. In some courses surgeons practice on pigs whose gallbladder Anatomy most closely resembles that of humans. In other courses no animal work is smaller scars from new operations View through Laparoscope Laparoscope entering body instruments put traction on the diseased Organ and surgeon attaches clips to artery and duct then cuts Between the clips. Then surgeons work to wrest the gallbladder from its attachment to the liver. Once released the gallbladder is pulled through one of the Small holes. The patient usually goes Home the next Day with Only four punctures to form scars. Sources Harvard Modecai latter Quot Atlas of a  Quot Page 16 the stars and stripes tuesday August 21, 1990 done. Some doctors do their first few cases Only when a More experienced colleague assists them. Others tackle a Case Straightaway. In the Rush surgeons have rejected suggestions that the procedure be confined to specialized medical centers until its track record is established. Quot Hopes for critical assessment of the procedure have pretty much gone by the boards a Mcsherry said. No one knows precisely How Many surgeons have taken courses to learn the new technique or How Many such procedures have been done in the United states. Or. Eddie Joe Reddick of Nashville tenn., and a Pioneer of the technique estimated that 5,000 have taken an introductory course and about 200 have actually done several thousand cases. Surgeons perform the new procedure in its entirety by watching a video Monitor connected to the Laparoscope a device that contains a Light and a camera that magnifies the image 16 times. Manipulating instruments under such circumstances requires development of tactile senses manual dexterity and other surgical skills entirely different from those used in open operations. The skills Are easily Learned but take time and experience to master. To a visitor watching the new procedure it was As if the surgeons were navigating a submarine through underwater glaciers while watching a video Monitor. The gallbladder is attached to the underside of the liver in the upper right Side of the Abdomen just beneath the rib Cage where organs Are so tightly packed that complications from surgery can be disastrous. Bile which aids in digestion is made in the liver and flows through ducts to the Small intestine. As it passes through the main duct much of the bile is channelled to the gallbladder where it is stored until it is needed after a meal. Removal of the gallbladder does not interfere with digestion. The main concerns of surgical injury Are bleeding and damage to the main bile duct. The procedure has been carried out in Many hospitals across the country. But the number of operations Are limited for now by a backlog of orders for the Laparoscope and other key instruments which Are made by hand principally by two companies in West Germany