Cholecystectomy

General Surgery Procedures

INTRODUCTION:

Purpose:

• removal of gall bladder

Causes:

• Cholelithiasis - common
• Cholecystisis - common
• Cholangiocarcinoma

Types:

• Open Cholecystectomy
• Laparoscopic Cholecystectomy - AKA "Lap Chole"

MATERIALS:

Misc
Back Table/Mayo Laproscopic Instruments

• Suction
• Scissors
• Cautorizer
• Grasper
• Bag
• Stapler

STEPS:

• 1)Patient prep:
  • Region: Umbilicus with Prep Fluid
• 2)Draping
• 3)Incision line marked
• 4)Incision line with scalpel (preference #11/#15)
• 5)Pneumoperitoneum is established w/ veres needle
  • a)2X silk sutures
    • Hemostat weighted
• 6)Trocars as advanced
  • Bladed or Non Bladed
• 7)Visual inspection of cavity and preparation -
  • abnormalities
  • locate gall bladder
• 8)Laproscopic manipulation - clearing and traction on liver
• 9)Arteries and ducts are exposed carefully but bluntly
  • Cholangiogram maybe utilized
• 10)Trinity of staples applied to arteries and ducts
  • two from source one from organ
• 11)Vessel/duct is cut in between the three staples
• 12)Gall bladder is freed from the liver
  • Optional bag utilized
  • Excess contents suctioned
• 14)Gall bladder removed
• 15)Laproscopic breakdown and pneumoperitoneum breakdown
• 16)Incisions are sutured
  • Largest port #0, with #2-0
• 17)Breakdown (Surgical area, sterile and nonsterile instrumentation is done in a concerted process)
• Surgical Area Breakdown while Finalizing Incisions:
  • • Conclusion left at discretion of surgeon
    • Steri strips are applied to help stabilize the sutures
    • Breakable glue Mastisol is utilized
    • Bismouth Petroleum Dressing Xeroform is placed
    • Antibiotic ointment
    • 4X4 is used to cover the areas
• Sterile Instrument Breakdown:
• 19)Surgery is Finalized
• 20)Patient wakes up (missing a gall bladder)- FINI :O