Overview
Laparoscopic Cholecystectomy is a minimally invasive surgical procedure used to remove the gallbladder. It is the standard treatment for symptomatic gallstones and gallbladder disease.
Laparoscopic cholecystectomy is crucial for treating symptomatic cholelithiasis, cholecystitis, and gallbladder polyps. It provides faster recovery and less pain compared to open surgery.
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Indications
Gallstones causing symptoms
Inflammation of gallbladder
Suspicious polyps
Recurrent pain episodes
Long-term inflammation
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, preoperative antibiotics, positioning, equipment setup, and team briefing. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Position patient, prep and drape, establish pneumoperitoneum.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- Inadequate prep
- Wrong pressure
💡 Pro Tip:
Position patient supine with arms abducted.
Step 2: Port Placement
Insert ports: umbilical (10mm), epigastric (10mm), RUQ (5mm), LUQ (5mm).
⚠️ Common Mistakes to Avoid:
- Wrong port placement
- Port injury
💡 Pro Tip:
Use open technique for first port.
Step 3: Exploration
Systematically explore abdomen, identify gallbladder.
⚠️ Common Mistakes to Avoid:
- Incomplete exploration
- Missed pathology
💡 Pro Tip:
Always explore all quadrants.
Step 4: Calot Triangle Dissection
Dissect Calot triangle, identify cystic duct and artery.
⚠️ Common Mistakes to Avoid:
- Inadequate dissection
- Bile duct injury
💡 Pro Tip:
Use critical view of safety.
Step 5: Ligation
Ligate cystic duct and artery with clips.
⚠️ Common Mistakes to Avoid:
- Incomplete ligation
- Bile leak
💡 Pro Tip:
Place clips properly to prevent bile leak.
Step 6: Gallbladder Removal
Dissect gallbladder from liver bed, remove through port.
⚠️ Common Mistakes to Avoid:
- Liver injury
- Bleeding
💡 Pro Tip:
Stay in correct plane to avoid liver injury.
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Post-procedure Care
Post-procedure care involves monitoring for complications, early ambulation, pain management, and discharge planning when criteria are met.Complications & Management
Complication | Incidence | Signs | Management | Prevention |
---|---|---|---|---|
Bile duct injury | 0.3-0.7% | Bile leak, jaundice | ERCP, surgical repair | Critical view of safety |
Bleeding | 1-3% | Hemodynamic instability | Exploration, hemostasis | Careful dissection |
Infection | 3-8% | Fever, wound erythema | Antibiotics, drainage | Preoperative antibiotics |
Bile leak | 1-2% | Abdominal pain, bilious drainage | ERCP, drainage | Proper clip placement |
Clinical Pearls
Use critical view of safety to prevent bile duct injury.
Always explore all quadrants.
Place clips properly to prevent bile leak.
Stay in correct plane to avoid liver injury.
Use open technique for first port.
Monitor for complications post-operatively.
Always confirm anatomy before ligation.