Routine Lap Chole/cholangiogram

Routine laparoscopic cholecystectomy and operative cholangiogram is 15-20minutes procedure in my practice; the pneumoperitoneum is created with an optical trocar within seconds; The Calot triangle is dissected; the cystic artery branches are divided with diathermy on the gallbladder; the cystic duct is isolated, clipped and cannulated and an operative cholangiogram is performed in all cases; the cystic duct is further divided and ligated with PDS endoloops -- NB: no metal clips are left behind; a PDS endoloop ligature is in general more secure than clips and very useful in complicated cases when the clips are too small or have an increased risk to slip resulting in bile leak from the cystic duct stump.
The gallbladder is dissected with diathermy; note that the dissection is on the gallbladder which reduces the bleeding to nil and avoids damage to a duct of Luschka; being accurate is very important in all steps of the procedure and burning the liver during this basic dissection proves how inaccurate your technique is and how likely you are to cause injury to other organs when you use diathermy in other situations such as division of adhesions or other intrabdominal procedures involving bowel.
At the end of the surgery there should be minimal or no blood or bile contamination and no suction irrigation is necessary for this routine operation; a drainage system is very rarely employed in my practice even in severe acute cholecystitis. An endobag to retrieve the gallbladder is rarely necessary: through an hourglass effect the gallbladder is gently squeezed through a 12mm cut without need of enlarging the wound and definitely without spillage of bile and stones.

Category:

Science & Technology

Tags:

• Laparoscopy
• visiport
• cholecystectomy
• gallbladder
• gallstones
• bile
• duct
• leak
• injury
• Hasson
• pneumoperitoneum
• cholangiogram
• laparoscopy
• bowel
• obstruction
• laparotomy
• trocar
• insuflation