Laparoscopic Cholecystectomy by Dr R. K. Mishra

Laparoscopic Cholecystectomy Steps

1. Prepare the patient
2. Placement of first 10mm trocar (midline navel)
3. Creation of Pneumoperitinium
4. Final Diagnosis 
5. Place patient in Reverse Trendelenburg position slightly rotated to the left
6. Apply local anesthetics and 2-3 other trocars under visualization of scope
7. Retraction of gall bladder/liver
8. Assistant grasps fundus of gallbladder and retract superiorly
9. Grasp infundibulum of the gallbladder (may need some dissecting)
10. Create tension by pulling slightly superior and laterally on the infundibulum of the gall bladder
11. Dissect Calot’s Triangle starting towards the infundibulum of the gall bladder and working your way to the common bile duct 
12. Using the gallbladder as point of reference, place 2 distal clips and 1 proximal clip along the cystic duct. 
13. Divide making sure both jaws are visible to prevent vascular injury
14. Using the gallbladder as point of reference, place 2 distal clips and 1 proximal clip along the cystic artery. 
15. Divide and cauterize/clip any necessary collateral arteries
16. Dissect away the posterior wall of the gall bladder
17. Remove gallbladder via bag or trocar
18. Irrigate and Suction
19. Final visualization check
20. Release of CO2 and suture trocar incisions
21. Transfer to PACU
22. Discharge typically within 24 hours
23. Post-operative pain can typically be relieved with OTC pain medications
24. Patient can resume normal daily activities in roughly 24 hours
25. Heavy lifting should be avoided for a few weeks
26. Watch for drainage, bleeding, swelling around incision sites, and for mild fever, as this could indicate complication

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