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Laparoscopic Cholecystectomy (Complications (Conversion to open procedure:…
Laparoscopic Cholecystectomy
Principals
Dissect and Remove GB
Gallbladder dissected off liver and removed via
umbilical port.
Identify and Clip CA and CD
Retract gallbladder upwards and identify Calot’s triangle
Sup: inferior edge of liver
Med: CHD
Inf: cystic duct
Contains: cystic artery, Calot’s/Lund’s node ±
aberrant RHA
Key to ID cystic duct and cystic artery and differentiate from CBD and RHA – “critical view of safety”
Clip CD and CA.
May use operative cholangiogram to confirm absence of stones in CBD.
Establish Pneumoperitoneum
Dissect down to and open the peritoneum @ umbilicus
Insert lap port and establish pneumoperitoneum
Insert 3 further ports under direct vision
Epigastrium
R costal margin
R flank
Complications
Conversion to open procedure: 5%
CBD injury: 0.3%
Bile leak
Retained stones
Intra-abdominal haemorrhage
May be controlled by compressing the hepatic
artery in the free edge of the Foramen of Winslow
Pringle’s Manoeuvre
Jaundice After Cholecystectomy
Post-hepatic
Gallstone retention
Biliary sepsis
Thermal injury - why blunt dissection preferred
Ligation of common hepatic or common bile duct
Pre-hepatic
Haemolysis after transfusion
Hepatic
Halogenated anaesthetics