Laparoscopic Cholecystectomy Steps

1. Prepare the patient
2. Placement of first 10mm trocar (midline navel)

2/10/2018 10:30:00 PM

Patients with Asymptomatic Cholelithiasis developed symptoms at a rate of approximately 1% to 2% per year.

Complications if surgery is not done were rare (approximately 4% over 25 years) except when preceded by biliary colic.

Complications typically include acute cholecystitis (0.3% per year), obstructive jaundice (0.2% per year), acute pancreatitis (0.04% to 1.5% per year), and gallstone ileus (rare)

Reference

http://www.aafp.org/afp/2014/0315/p468.html

5/04/2016 03:39:00 PM

5/04/2016 01:33:00 PM

• Preparation of the patient 
• Placement of first trocar (midline navel)
• Creation of Pneumoperitinium
• Place patient in Reverse Trendelenburg position slightly rotated to the left
• Apply local anesthetics and 2-3 other trocars under visualization of scope

• Assistant grasps fundus of gallbladder and retract superiorly
• Grasp infundibulum of the gallbladder
• Create tension by pulling slightly superior and laterally on the infundibulum of the gall bladder
• Dissect Calot’s Triangle starting towards the infundibulum of the gall bladder and working your way to the common bile duct 
• Using the gallbladder as point of reference, place 2 distal clips and 1 proximal clip along the cystic duct. 
• Divide making sure both jaws are visible to prevent vascular injur
• Using the gallbladder as point of reference, place 2 distal clips and 1 proximal clip along the cystic artery. 

Source: Dr Cara Lawrence, University of Kentucky

• Divide and cauterize/clip any necessary collateral arteries
• Dissect away the posterior wall of the gall bladder using Hook. 
• Remove gallbladder via bag or trocar
• Irrigate and Suction
• Final visualization check
• Irrigate and suction
• Release of CO2 and suture trocar incisions

Video Link 1: Click here
Video Link 2: Click here

References

• Dr Cara Lawrence, University of Kentucky http://www.mc.uky.edu/mis/ppt/Laparoscopic%20Cholecystectomy_v2.ppt

4/23/2016 02:30:00 AM