Grasper trauma during laparoscopic cholecystectomy

Background: The present study characterized the histopathological nature of laparoscopic grasper trauma during laparoscopic cholecystectomy in a prosp ective, blinded trial in order to establish a model for laparoscopic graspe r trauma. The null hypothesis that graspers cause no histologically distinc t tissue injury was tested. Methods: The gall bladders of 19 patients undergoing laparoscopic cholecyst ectomy were examined. The area of gall bladder that had been grasped by Deb akey laparoscopic forceps was excised (sample), along with an area of gall bladder that had not been grasped (control). Paired specimens were examined by a pathologist (blinded) to identify which was 'sample' and which was 'c ontrol' and to assess for histological markers of crushed tissue injury. Th e data were analysed by chi-squared or Fisher's exact tests. Results: The pathologist was able to identify the sample (gripped) specimen in 13 of the 19 cases. In the remaining six cases the pathologist was unab le to determine the specimen that had been gripped due to either absence of damage (four cases), or severe inflammation precluding assessment (two cas es). The ability of the pathologist to distinguish the sample from the cont rol specimen was significant (chi-squared test, P = 0.003), Of the histolog ical markers of crushed tissue injury, focal thinning of the gall bladder w all and epithelial loss were present in significantly more sample (gripped) specimens than control specimens (chi-squared test, P = 0.0002 and P < 0.0 001. respectively). Conclusions: Laparoscopic graspers cause tissue trauma that can be assessed histologically. The current study presents a relevant, reproducible, ethic ally acceptable human model for assessing the interaction between laparosco pic graspers and soft tissues.