Laser Laparoscopic Cholecystectomy: A State-of-the-Art Assessment

Laparoscopic cholecystectomy is one of the hottest new procedures for the general surgeon. The invasive removal of the gallbladder is replaced by a less invasive approach, using the laparoscope as an access and viewing system and lasers, cutters, staplers, and other microinstrumentation to perform the therapeutic procedure. Although certain hardware (e.g., KTP laser) has been promoted on the basis of laparoscopic cholecystectomy, there seems to be general confusion over whether a laser is necessary, what the advantages of using a laser may be, and which laser is best for this procedure. Several different laser wavelengths may be useful for laser laparoscopic cholecystectomy (LLC). However, it is not clear at this stage—even among the experts—whether primarily a cutting or coagulation function is desirable from the laser. In this article, we explore some of the options available for performing LLC, present comments from interviews with several of the experts in laparoendoscopic surgery, and look at the future of the technologies and applications that will evolve from today's LLC procedure. Although there remain unanswered questions about the technologies used in LLC, we hope that the information provided will help clarify the current state-of-the-art as defined by the technologists and the clinical thought-leaders.