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Introduction Laparoscopic cholecystectomy is a common procedure in general surgery, and in complex cases it is important for the surgeon to know all the alternatives with low associated morbidity. Laparoscopic subtotal cholecystectomy should be considered as an option when a critical view of safety cannot be obtained, because it has a low complication rate and gives the advantages of minimally invasive surgery. Methods Retrospective study of laparoscopic subtotal cholecystectomies in an eight years period. Results A total of 1059 laparoscopic cholecystectomies were performed; 22 were subtotal cholecystectomies, without conversion. Biliary fistula (9%) and intraabdominal collections (4.5%) were the most common complications described. No iatrogenic bile duct injuries or deaths were reported. Our follow-up period was 32 months, no recurrences were reported. Conclusions Laparoscopic subtotal cholecystectomy is a safe and effective procedure. It should be considered as an option in complex cases.

Resumen Introduccion La colecistectomia laparoscopica es uno de los procedimientos quirurgicos realizados con mas frecuencia a nivel mundial en el campo de la cirugia general, por lo que es fundamental que el cirujano conozca las diferentes alternativas al momento de enfrentarse con un caso complejo. Bajo esta premisa, es importante considerar la colecistectomia laparoscopica subtotal como una opcion, cuando despues de una adecuada diseccion, no se logra identificar las estructuras anatomicas y no se obtiene la vision critica de seguridad. Este procedimiento cursa con baja morbilidad y con las ventajas ampliamente conocidas de la cirugia minimamente invasiva. Metodos Estudio retrospectivo de pacientes a quienes se les realizo colecistectomia laparoscopica subtotal en un periodo de 8 anos. Resultados Se realizaron 1.059 colecistectomias laparoscopicas. De estas, 22 correspondieron a colecistectomias subtotales. No se registraron lesiones de via biliar ni conversiones. Las complicaciones mas frecuentes fueron la fistula biliar (9%) y la coleccion intraabdominal (4,5%). No hubo mortalidad asociada al procedimiento. Durante un periodo de seguimiento promedio de 32 meses, no se observo recurrencia de sintomatologia. Conclusiones La colecistectomia laparoscopica subtotal es un procedimiento efectivo, seguro y reproducible. Debe ser considerada como una opcion en casos complejos.

Over the years, incisional hernia repair has evolved. Currently, primary closure of the defect before placing the mesh is a critical step in incisional hernia repair and minimally invasive surgery incorporation has an important role due to great advantages. Despite its benefits, laparoscopic closure with suture intracorporeal knotting is physically demanding and technically complex. Robotic technology provides an optimal three-dimensional view, maneuverability of the instruments but no study has assessed the impact of the DaVinci system in the ergonomics which is the objective in this study. Fourteen surgeons were able to achieve surgical repair of a defect in an incisional hernia inanimate model. The task was performed with conventional laparoscopy and robotic assistance. The mental effort was registered and physical disturbances were measured with the Local Experienced Discomfort scale. The subjects expressed discomfort mainly in the dominant side (p = 0.006). In the comparative analysis between the two approaches, upper limb less disturbance (p = 0.04) and lower mental effort (p = 0.001) were reported with robotic approach. Robotic assistance decreases mental and physical effort during the primary closure of a defect in an incisional hernia inanimate model.