Tag Archives: interval

PUBLISHED: Robotic-Assisted Laparoscopic Interval Cholecystectomy

Robotic-Assisted Laparoscopic Interval Cholecystectomy
Chloe A. Warehall, MD1Divyansh Agarwal, MD, PhD1Charu Paranjape, MD, FACS1,2
1Massachusetts General Hospital
2Newton-Wellesley Hospital

Acute cholecystitis occurs when gallstones become impacted in the neck of the gallbladder or cystic duct in approximately 90–95% of cases. Symptoms may include acute right upper quadrant pain, fever, nausea, and emesis often associated with eating. Acute cholecystitis generally has imaging findings of gallbladder wall thickening, edema, gallbladder distension, pericholecystic fluid, and positive sonographic Murphy sign. However, acute cholecystitis is largely a clinical diagnosis of persistent right upper quadrant (RUQ) pain and associated tenderness on palpation of the RUQ in the setting of gallstones.

The standard treatment is a cholecystectomy to prevent recurrent cholecystitis or sequelae of gallstones. Timing of the cholecystectomy is dependent on length of symptoms, which reflect the degree of inflammation.  This is the case of a 74-year-old male who presented with six days of acute cholecystitis symptoms who was initially managed with antibiotics. After improvement of his pain and no systemic symptoms of infection, he underwent an interval robotic cholecystectomy. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.

PUBLISHED: Laparoscopic Interval Appendectomy and Open Umbilical Hernia Repair

Laparoscopic Interval Appendectomy and Open Umbilical Hernia Repair
John Grove1Naomi Sell, MD2Thomas O’Donnell, MD2Noelle N. Saillant, MD2
1Lincoln Memorial University – DeBusk College of Osteopathic Medicine
2Massachusetts General Hospital

Acute appendicitis is a medical condition where the appendix becomes inflamed and causes pain in the lower right quadrant of the abdomen. In addition to pain, appendicitis can cause peritonitis, perforations, and can lead to death if left untreated. Laparoscopic appendectomy is the standard surgical procedure to treat the symptoms of appendicitis as well as prevent further spread of infection. While appendicitis typically advances in an irreversible fashion necessitating surgery, conservative management with antibiotic therapy can sometimes resolve symptoms.

In this case, a 24-year-old patient had a delayed presentation with acute perforated appendicitis. Following successful non-operative treatment with antibiotics, she presented for a laparoscopic interval appendectomy. She also had a non-symptomatic umbilical hernia, which was repaired following removal of the laparoscopic ports for the appendectomy.