Bulletin Spring‧Summer Autumn‧Winter 1999

The first case of laparoscopic cholecystectomy in Hong Kong was performed successfully in June 1990 by a team of doctors from the Department of Surgery of the University at the Prince of Wales Hospital in Sha Tin. A 41-year-old man with gallstones had his diseased gall bladder removed through his umbilicus without having his abdomen cut open. Cholecystectomy (removal of the gall bladder) is one of the commonest surgical operations. Traditionally, it requires an abdominal incision of at least 10 cm in length. The wound is often painful and the abdomen is permanently scarred. Moreover the patient Laparoscopy (looking through a telescope inside the abdomen) has been in use for some years but combining this procedure with cholecystectomy is a recent innovation. In laparoscopic cholecystectomy, the surgeon inserts a laparoscope through the umbilicus. A television camera is attached to the laparoscope to give a view inside the abdomen. Surgical instruments are then inserted through small puncture holes in the abdomen to dissect out the gall bladder, which in turn is removed through the umbilicus. The patient, a supplies supervisor with the Auxiliary Air Force, had been suffering from gallstones for over 10 years and had a diseased gall bladder. The operation was carried out smoothly and successfully under general anaesthesia on 21st June 1990 by Dr. S.C. Sydney Chung and his team. There was minimal discomfort after the operation so much so that the patient was able to get out of bed by himself that same evening. The next day, he was eating normally and was walking around without pain. He returned to normal activities one wee k after the procedure. The puncture sites through which the laparoscope and instruments wer e inserted were hardly visible by one week. Compared to traditional cholecystectomy, laparoscopic surgery minimizes the trauma o f the operation. From the patient's point of view, postoperative discomfort is greatly decreased and the return to full activities is much faster. Cosmetically, the scarring from laparoscopic cholecystectomy is minimal. Because of the decrease in hospital stay, savings on hospital costs can be substantial. Moreover an earlier return to normal activities and work will have considerable benefits to the community. This surgical technique can also apply to appendectomy, removal of the ovary and other abdominal operations but is not suitable for pregnant women, those who have had operations before, and those suffering from cholecystitis. Laparoscopic cholecystectomy is a major advance in the treatment of gall bladder disease. Preparation for this operation by the Department of Surgery of the University at the Prince o f Wales Hospital extended over half a year. A team of surgeons first practised laparoscopic surgery using plastic models and then perfected their skills on anaesthesized pigs. The operation on a patient was only carried out after all the technical difficulties had been ironed out in animal experiments. The successful operation was the fruition o f over six months of experimentation and preparation. The medical equipment currently in use for the operation, costing HK$ 140,000, was bought by Prof. Arthur K.C. L i in person from London. The University w i ll be holding workshops in the near future to teach other surgeons who wish to learn this new technique. 11