PDF(Pubmed)
Abstract：
OBJECTIVE: Laparoscopic cholecystectomy, introduced in 1985 by Prof. Dr. Erich Mühe, has become the gold standard for treating chronic symptomatic calculous cholecystopathy and acute cholecystitis, with an estimated 750,000 procedures performed annually in the United States of America. The risk of iatrogenic bile duct injury persists, ranging from 0.2 to 1.3%. Risk factors include male gender, obesity, acute cholecystitis, previous hepatobiliary surgery, and anatomical variations in Calot\'s triangle. Strategies to mitigate bile duct injury include the Critical View of Safety and fundus-first dissection, along with intraoperative cholangiography and alternative approaches like subtotal cholecystectomy.
METHODS: This paper introduces the shoeshine technique, a maneuver designed to achieve atraumatic exposure of anatomical structures, local hemostatic control, and ease of infundibulum mobilization. This technique involves the use of a blunt dissection tool and gauze to create traction and enhance visibility in Calot\'s triangle, particularly beneficial in cases of severe inflammation. Steps include using the critical view of safety and Rouviere\'s sulcus line for orientation, followed by careful dissection and traction with gauze to maintain stability and reduce the risk of instrument slippage.
RESULTS: The technique, routinely used by the authors in over 2000 cases, has shown to enhance patient safety and reduce bile duct injury risks.
CONCLUSIONS: The shoeshine technique represents a simple and easy way to apply maneuver that can help surgeon during laparoscopic cholecystectomies exposing the hepatocystic area and promote blunt dissection.
METHODS: This paper introduces the shoeshine technique, a maneuver designed to achieve atraumatic exposure of anatomical structures, local hemostatic control, and ease of infundibulum mobilization. This technique involves the use of a blunt dissection tool and gauze to create traction and enhance visibility in Calot\'s triangle, particularly beneficial in cases of severe inflammation. Steps include using the critical view of safety and Rouviere\'s sulcus line for orientation, followed by careful dissection and traction with gauze to maintain stability and reduce the risk of instrument slippage.
RESULTS: The technique, routinely used by the authors in over 2000 cases, has shown to enhance patient safety and reduce bile duct injury risks.
CONCLUSIONS: The shoeshine technique represents a simple and easy way to apply maneuver that can help surgeon during laparoscopic cholecystectomies exposing the hepatocystic area and promote blunt dissection.
摘要：
目的：腹腔镜胆囊切除术，1985年由教授介绍。ErichMühe博士,已成为治疗慢性症状性结石性胆囊炎和急性胆囊炎的金标准，估计每年在美利坚合众国进行750,000次手术。医源性胆管损伤的风险仍然存在，从0.2%到1.3%不等。危险因素包括男性，肥胖，急性胆囊炎,以前的肝胆手术，和Calot三角形的解剖学变化。减轻胆管损伤的策略包括安全和眼底优先解剖的关键观点，术中胆道造影和其他方法，如胆囊次全切除术。
方法：本文介绍了擦鞋技术，一种旨在实现解剖结构的无创伤暴露的策略，局部止血控制,易于漏斗动员。这项技术涉及使用钝性解剖工具和纱布来产生牵引力并增强Calot三角形的能见度，在严重炎症的情况下特别有益。步骤包括使用安全的关键视图和Rouviere的沟线进行定向，然后用纱布仔细解剖和牵引，以保持稳定性并减少仪器打滑的风险。
结果：技术，作者在2000多个案例中经常使用，已证明可以提高患者的安全性并降低胆管损伤的风险。
结论：擦鞋技术代表了一种简单易行的方法，可以帮助外科医生在腹腔镜胆囊切除术中暴露肝囊区域并促进钝性解剖。
方法：本文介绍了擦鞋技术，一种旨在实现解剖结构的无创伤暴露的策略，局部止血控制,易于漏斗动员。这项技术涉及使用钝性解剖工具和纱布来产生牵引力并增强Calot三角形的能见度，在严重炎症的情况下特别有益。步骤包括使用安全的关键视图和Rouviere的沟线进行定向，然后用纱布仔细解剖和牵引，以保持稳定性并减少仪器打滑的风险。
结果：技术，作者在2000多个案例中经常使用，已证明可以提高患者的安全性并降低胆管损伤的风险。
结论：擦鞋技术代表了一种简单易行的方法，可以帮助外科医生在腹腔镜胆囊切除术中暴露肝囊区域并促进钝性解剖。
