This document provides information about a laparoscopic cholecystectomy procedure to remove the gallbladder. It describes the anatomy of the gallbladder and its connection to the liver and small intestine. It explains that a laparoscopic cholecystectomy is the standard minimally invasive procedure, which uses several small incisions and a laparoscope to remove the gallbladder. The procedure involves inflating the abdomen with carbon dioxide, inserting instruments through ports to clip and remove the gallbladder, then closing the incisions. Recovery typically allows discharge within 1-2 days and a return to normal activities within a week.

1. Cholecystectomy
An overview

2. Cholecystectomy
+ A cholecystectomy is surgery to remove your gallbladder.

3. Anatomy of the
Gallbladder
The gallbladder lives on
the inferior aspect of the
liver bed, more
specifically under liver
segments 4b and 5. The
gallbladder can be up to
10 cm in length and
physiologically can hold
up to 50 cc of fluid (bile)

4. Anatomy of the
Gallbladder
With the liver, it
attaches to the small
intestine through a
series of tubes called
ducts

5. + Gallbladder - pear-shaped pouch underneath your liver.
-The gallbladder stores a digestive juice called bile which is made in the liver.
+ Bile, a substance made by the liver to break down fat, is stored in the gallbladder.
+ Cholecystectomy is usually done when there is evidence of gallbladder disease, such as
gallstones or polyps.
+ Gallstones are hard asses formed in the gallbladder
+ Gallstones may cause obstruction of the cystic duct and excruciating pain when the gallbladder
contracts. This usually happens after a fatty meal and is commonly referred to as gallbladder attack.

6. + Laparoscopic cholecystectomy is currently the standard
procedure for gallbladder removal. This minimally invasive
procedure requires only several small keyhole incisions in
the abdomen known as ports.
+ The patient is often discharged from the hospital on the
same day of surgery or within 1 or 2 days and resumes full
activity and employment within 1 week after the procedure.

7. LAPARASCOPIC CHOLECYSTECTOMY
PROCEDURE
• To reach the gallbladder, the surgeon
surgeon will insert tubes called
trocars through these ports.
• One port is usually located at the
navel, or umbilicus.
• Carbon dioxide gas pumped through
through the umbilical port will inflate
inflate the abdomen, so its contents
contents can be viewed more easily.
easily.

8. • Next, the surgeon will insert the
laparoscope through the umbilical
port.
• Images from its camera will be
transmitted to a video monitor in
the operating room.

9. • Using instruments passed through
other ports, your surgeon will
grasp the gallbladder, clip off its
main artery and duct, drop it into
a specimen bag, and remove it
through one of the ports.
• After the laparoscope is removed,
a port value will be left in place
briefly, to allow all of the carbon
dioxide to escape from the
abdomen.
• The incisions will be closed with
sutures, followed by skin glue or
skin closure tape.

10. Laparoscopic Cholecystectomy

11. FDAR

12. + Nurses Notes
Date
September
13,2022
Time
8:00 am
Focus
Impaired gas
exchange
D-ata A-ction R-esponse
D- Received patient awake, conscious, coherent sitting on bed. c 02
of High flow of F102 100%. c HL @ RA. Patient observed to have
DOB especially talking and when placed in supine position. SPO2
of 94%, RR of 21 bpm. Patient claimed “Gakabudlayan ko mag
ginhawa kung ang posisyon ko maghigda ga flat.”---------------
A- vital signs continuously monitored & recorded. Breathing pattern
monitored recorded. Provided health teaching about deep breathing
and pursed lip breathing exercises. Encouraged patient to have and
upright position always. Assisted the patient by elevating the head
of the bed. Advised not have strenuous activities. Administered
medication as ordered. Dr. Alayon visited c orders carried out a
noted by staff nurse. Referred to Respiratory care therapist.-----------
--------------------------------------------------------------
R- Patient verbalized understanding of the instruction. Patient able
to demonstrate proper pursed-lip breathing. Latest RR 19 bpm, 02
sat of 97% -------------------------------------------------------------------------
Gabriel Divine S. Mortel SN/ Marisa Espuerta- Ejusa
SN CSAB Clinical Instructor

13. + Nurses Notes
Date
September
13,2022
Time
8:00 am
Focus
Increased
Body
Temperature
D-ata A-ction R-esponse
D- Temp: 37.9 C -------------------------------------------------------------------
-->Warm to touch. -----------------------------------------------------------------
---
>Verbalized “Daw ginapanugnawan ko.“-----------------------------------
A-Monitored temperature Q1---------------------------------------------------
>Gave PRN medication-Paracetamol 500mg P.O
>Encouraged increased fluid intake. TSB done.---------------------------
R- Latest temp: 37.6 C------------------------------------------------------------
--
>Continued TSB done by folks. Verbalized “Daw wala nako gina
palamugnaw.”
Gabriel Divine S. Mortel/ Gregorio Alojado RN, MN
SN-CSAB Clinical Instructor