**1. Introduction**

36 Updated Topics in Minimally Invasive Abdominal Surgery

[12] Friedman LS. The risk of surgery in patients with liver dis ease. Hepatology 1999;

[14] Charles M. Haberkern, Lynne D. Neumayr, Eugene P. Orringer,Ann N. Earles, Shanda

[15] Delis S, Bakoyiannis A, Madariaga J, Bramis J, Tassopoulos N, Dervenis C. Laparoscopic

[16] Leone N, Garino M, De Paolis P, Pellicano R, Fronda GR, Rizzetto M. Laparoscopic

[17] Modrzejewski A, Lewandowski K, Pawlik A, Czerny B, Kurzawski M, Juzyszyn Z. [Gall

[18] Comitalo JB, Lynch D. Laparoscopic cholecystectomy in the pregnant patient. Surg

[19] Abuabara SF, Gross GW, Sirinek KR. Laparoscopic cholecystectomy during pregnancy

[20] Reyes-Tineo R. Laparoscopic cholecystectomy in pregnancy. Bol Asoc Med P R. 1997

[21] Wishner JD, Zolfaghari D, Wohlgemuth SD, Baker JW Jr, Hoffman GC, Hubbard GW,

[23] Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973). "Transection of

[24] Julio Mayol, Javier Martinez Sarmiento, Francisco J. Tamayo, Jesus Alvarez Fernandez Represa. Age Ageing (1997) 26 (2): 77-81.doi: 10.1093/ageing/26.2.77 [25] Ekici Y, Karakayali F, Yagmurdur MC, Moray G, Karakayal H, Haberal M.

[26] O. Banli, N. Guvence, H. Altun Transplantation Proceedings.June 2005 (Vol. 37, Issue 5,

[27] Yeh CN, Chen MF, Jan YY. Laparoscopic cholecystectomy for 58 end stage renal disease

Group. Blood, Vol. 89 No. 5 (March 1), 1997: pp. 1533-1542

Jun 24. PubMed PMID: 19551433.

Surg Laparosc Endosc Percutan Tech. 2009

Laparosc Endosc. 1994 Aug;4(4):268-71.

2001 May 2. PubMed PMID: 11591971

(8): 646–9.doi:10.1002/bjs.1800600817

Apr;19(2):101-5. PubMed PMID: 1939027

Jan-Mar;89(1-3):9-11. Review.

M. Robertson, Dennis Black, Miguel R. Abboud, Mabel Koshy, Olajire Idowu, Elliott P. Vichinsky, and the Preoperative Transfusion in Sickle Cell Disease Study

cholecystectomy in cirrhotic patients: the value of MELD score and Child-Pugh classification in predicting outcome. Surg Endosc. 2010 Feb;24(2):407-12. Epub 2009

cholecystectomy in cirrhotic patients. Dig Surg. 2001;18(6):449-52. PubMed PMID:

bladder stones during pregnancy in the age of laparoscopic cholecystectomy]. Ginekol Pol. 2008 Nov;79(11):768-74. Review. Polish. Machado NO, Machado LS. Laparoscopic cholecystectomy in the third trimester of pregnancy: report of 3 cases.

is safe for both mother and fetus. J Gastrointest Surg. 1999 Jan-Feb;1(1):48-52;

Gould RJ, Ruffin WK. Laparoscopic cholecystectomy in pregnancy. A report of 6 cases and review of the literature. Surg Endosc. 1996 Mar;10(3):314-8. Review. [22] Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcomes analysis of laparoscopic

cholecystectomy in the extremely elderly. Surg Endosc. 2001 Jul;15(7):700-5. Epub

the oesophagus for bleeding oesophageal varices". The British journal of surgery 60

Laparoscopic cholecystectomy in patients undergoing continuous ambulatory peritoneal dialysis: a case-control study. Surg Laparosc Endosc Percutan Tech. 009

patients. Surg Endosc. 2005 Jul;19(7):915-8. Epub 2005 May 3. PubMed PMID:

29:1617-23.

11799294.

discussion 52.

Pages 2127-2128)

15868265.

The first cholecystectomy was performed by Langenbuch in 1882 (1), and the surgical approach changed very little in the next century. However, in the 1980s, reports began to appear that described the removal of the gallbladder through a 3-8 cm, muscle-sparing incision (small-incision cholecystectomy, or minicholecystectomy) (2-17). A few years later, laparoscopic cholecystectomy entered the scene (18, 19). These two minimally-invasive techniques have largely replaced the traditional open cholecystectomy, which used a 10 – 20 cm incision in elective gallbladder surgery (20). In 1993, a consensus conference at the National Institute of Health concluded that the experience of small-incision surgery or minilaparotomy cholecystectomy was limited; and that laparoscopic cholecystectomy could be performed at a treatment cost that was equal to or slightly less than that of open cholecystectomy and offered substantial cost savings to the patient and society by reducing the time off work (21). The alternative to surgical removal of the gallbladder, lithotripsy combined with chemical dissolution of gallstones is restricted to single stone disease and runs a risk of stone recurrence (22, 23). However, it has been found to be associated with good long-term quality of life in selected patients (24).

The aim of this review is to discuss factors that influence the choice between cholecystectomy techniques, taking into account the applicability and cost of each technique.

### **2. Methods**

We conducted a literature search, including a search of the Cochrane Library and PubMed (year 2010) with the keyword "cholecystectomy" and used the principles of evidence based medicine in the presentation of the findings (25-29).
