Laparoscopic Cholecystectomy Steps
- Prepare the patient
- Placement of first 10mm trocar (midline navel)
- Creation of Pneumoperitinium
- Final Diagnosis
- Place patient in Reverse Trendelenburg position slightly rotated to the left
- Apply local anesthetics and 2-3 other trocars under visualization of scope
- Retraction of gall bladder/liver
- Assistant grasps fundus of gallbladder and retract superiorly
- Grasp infundibulum of the gallbladder (may need some dissecting)
- 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 injury
- Using the gallbladder as point of reference, place 2 distal clips and 1 proximal clip along the cystic artery.
- Divide and cauterize/clip any necessary collateral arteries
- Dissect away the posterior wall of the gall bladder
- Remove gallbladder via bag or trocar
- Irrigate and Suction
- Final visualization check
- Release of CO2 and suture trocar incisions
- Transfer to PACU
- Discharge typically within 24 hours
- Post-operative pain can typically be relieved with OTC pain medications
- Patient can resume normal daily activities in roughly 24 hours
- Heavy lifting should be avoided for a few weeks
- Watch for drainage, bleeding, swelling around incision sites, and for mild fever, as this could indicate complication
Check out these related videos:
GROSS ANATOMY AND SEGMENTAL ANATOMY OF LIVER
LAPAROSCOPIC APPENDECTOMY BY DR ANDREW RENAUT
PRINCIPLES OF BOWEL ANASTOMOSIS WITH VIDEOS
MOST IMPORTANT ANATOMY IN DIAGNOSTIC LAPAROSCOPY
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