The document outlines the procedure for laparoscopic cholecystectomy, including indications, contraindications, anesthesia, positioning, surgical techniques, and post-operative care. It details the steps involved such as creating pneumoperitoneum, port placement, and critical views necessary for safe dissection. The risks associated with the surgery and the expected recovery timeline are also provided.

1. LAPAROSCOPIC
CHOLECYSTECTOMY
DR.B.Selvaraj MS; Mch; FICS;
“ Surgical Educator”
Malaysia
OPERATIVE SURGERY

2. LAPAROSCOPIC CHOLECYSTECTOMY
• INDICATIONS:
 Symptomatic Cholelithiasis
 Porcelain Gall bladder
Biliary dyskinesia & Acalculous cholecystitis
• CONTRAINDICATIONS
Suspected malignancy
Dense intra-abdominal adhesions
• ANESTHESIA:
 GA/ETT
• POSITION:
 Supine- consider Xray table for IOC
• Informed consent- risks of surgery:
Bile leak- biliary fistula 0.5%
Peritonitis 0.1%
Missed stone 1%
Injury to bile duct 0.5%
Injury to liver, duodenum or colon 0.1%
Vascular injuries to portal vein or hepatic artery
0.1%
Abscess 0.2%
Conversion to open surgery if there are dense
adhesions

3. LAPARASCOPIC CHOLECYSTECTOMY
• Position: Patient & Surgeon
 Patient in supine position. Both arms
can be tucked, or only the left arm can be
tucked.
The surgeon patient’s left side
First assistant patient’s right side.
 Second assistant (camera holder)
patient’s left side below the surgeon.

4. LAPAROSCOPIC CHOLECYSTECTOMY
• Creating Pneumoperitoneum:
 Closed or Veress needle method
 Open or Hasson’s cannula method
CO2 Auto-insuffalator

5. LAPAROSCOPIC CHOLECYSTECTOMY
• Port placement
 Primary: Umbilicus- 10mm port-
laparoscopic telescope 30* angled
 Secondary: 5mm ports
- Epigastric- 5mm or 10 mm-
operating port
- Rt subcostal medial- 5mm port-
dynamic retractor
- Rt subcostal lateral- 5mmport- static
retractor
 Introduce secondary trocars under
laparoscopic vision

6. LAPAROSCOPIC CHOLECYSTECTOMY
• Dissection of Calot’s triangle
• Flagging of infundibulum
• Incising peritoneal covering
anteriorly and posteriorly
• Rouviere’s sulcus

7. LAPAROSCOPIC CHOLECYSTECTOMY
• Skeletonising cystic duct & cystic
artery
• Critical view of safety
• Elephant head appearance

8. LAPAROSCOPIC CHOLECYSTECTOMY
• For Intraoperative Cholangiogram

9. LAPAROSCOPIC CHOLECYSTECTOMY
• Clipping & dividing Cystic duct

10. LAPAROSCOPIC CHOLECYSTECTOMY
• Clipping & dividing Cystic artery

11. LAPAROSCOPIC CHOLECYSTECTOMY
• Retrograde removal of GB from GB bed and
hemostasis of GB bed

12. LAPAROSCOPIC CHOLECYSTECTOMY
• Extraction of Gall Bladder

13. LAPAROSCOPIC CHOLECYSTECTOMY
• Closure of Primary port Incision: • Post operative care
 Remove NGT on day of surgery and
drain if any on POD # 2 or 3
 Diet: Allow liquids after few hours and
then advance quickly
 Ambulate the patient immediately
 Post operative incentive spirometry or
breathing exercises
 Time off work: 3 to 7 days

14. LAPAROSCOPIC CHOLECYSTECTOMY

15. THANK YOU