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Laparoscopic Cholecystectomy by George Crawford, MD
Authored by
George Crawford, MD
Authored by
George Crawford, MD
Laparoscopic Cholecystectomy by George Crawford, MD
Operative Steps
Operative Steps
- Access is generally obtained by making an incision in the umbilicus.
- Usually, a 12 mm port is placed through the umbilical incision under direct visualization.
- The abdomen is insufflated.
- Generally, a subxiphoid 5mm trocar and two right subcostal trocars are placed.
- Any adhesions to the gallbladder are taken down using electrocautery or ultrasonic shears.
- The gallbladder is retracted superiorly and lateral.
- Electrocautery as well as blunt dissection is used to identify the Triangle of Calot.
- The cystic duct is identified. Two clips are placed proximally, and one is placed distally.
- The cystic artery is identified. Two clips are placed proximally, and one is placed distally.
- The cystic duct and the cystic artery are transected using scissors.
- The gallbladder is removed from the gallbladder fossa using electrocautery or an ultrasonic energy device such as HARMONIC™ 1100.
- Hemostasis is obtained while removing the gallbladder.
NOTE: Adjunctive hemostats such as SURGICEL SNoW™ or SURGICEL Powder™ may be used if the liver bed is oozing and where primary methods (energy, staples, sutures, or clips) are ineffective or impractical.
- The gallbladder is placed in an endoscopic specimen retrieval bag and removed through the 12 mm port.
- Commonly, a size 0 absorbable synthetic suture, like Vicryl™ Plus Antibacterial suture is used to close the fascia of the 12 mm trocar site.
- The remaining trocars are removed. The wounds are closed using synthetic absorbable suture, such as Monocryl™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND™ MINI™ Topical Skin Adhesive, or any appropriate dressing.
- The patient is extubated and taken to the recovery room.