Impact of thoracic outlet diameter on surgical outcomes in laparoscopic cholecystectomy

INTRODUCTION: This study assesses the influence of inferior thoracic aperture dimensions on the outcomes of laparoscopic cholecystectomy for cholelithiasis. It aims to determine if the size of the thoracic outlet, akin to pelvic measurements in obstetrics, can predict surgical complexity and complications.
METHODS: In this prospective anatomical and clinical study, 32 patients who underwent laparoscopic cholecystectomy between April 2014 and December 2015 at Bursa Yuksek Ihtisas Research and Training Hospital were evaluated. Anteroposterior (AP) and laterolateral (LL) diameters of the inferior thoracic aperture were measured using CT or MRI. The study focused on dissection time and intraoperative blood loss, quantitatively.

RESULTS: Twenty-three of 32 patients (71.9%) were female, and 9 (28.1%) were male. The mean age of the patients was 57.97±16.11 years (min: 29; max: 85). The mean overall dissection time was 1,172.43±427.58 seconds (min: 550; max: 2,157), and the median amount of intraoperative hemorrhage was 6.5 cc (min: 1; max: 23). The mean LL diameter of the patients was 26.02±2.29 cm (min: 21.50; max: 31.50), and the median value of the AP diameter was found to be 11.35 cm (min: 9.40; max: 19.40). A positive relationship was found between the LL and AP diameters (r=0.574; p=0.001). There was a negative relationship between operational time and both LL and AP diameters (r=-0.418; p=0.017 and r=-0.405; p=0.022).
DISCUSSION AND CONCLUSION: Findings suggest that narrower thoracic apertures can prolong the standard 4-port-access laparoscopic cholecystectomy procedure. This study underscores the importance of measuring thoracic outlet diameters for anticipating surgical difficulty in general surgery, analogous to pelvic measurements in obstetrics. Such measurements could be pivotal in preoperative planning and in improving surgical outcomes.