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.

Indications

Symptomatic Cholelithiasis

Gallstones causing symptoms

Acute Cholecystitis

Inflammation of gallbladder

Gallbladder Polyps

Suspicious polyps

Biliary Colic

Recurrent pain episodes

Chronic Cholecystitis

Long-term inflammation

Contraindications

Absolute Contraindications

Patient refusal
Uncorrected coagulopathy
Hemodynamic instability

Relative Contraindications

Previous extensive abdominal surgery
Pregnancy
Severe cardiopulmonary disease

📋 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.