This document discusses laparoscopic cholecystectomy, a surgical procedure to remove the gallbladder through small incisions using an endoscope. It outlines the indications, contraindications, anesthesia used, positioning of the patient and surgical team, steps of the procedure, advantages/disadvantages, postoperative care, and some key outcomes data. The overall message is that laparoscopic cholecystectomy is the gold standard gallbladder surgery, with benefits of smaller incisions, less pain and faster recovery compared to open surgery. Careful technique and recognition of anatomy is important to minimize complications.

1. Dr.NoushinNowar
InternDoctor
DepartmentofSurgery,
JananetaNurulHaqueAdhunikHospital,Noakhali.
LAPAROSCOPIC
CHOLECYSTECTOMY

2. Dr.Sardar A Nayeem,Dr.Hashimoto Taijo and the team in (1991)

4. Either open or laparoscopic
Indication
• Cholecystitis
• Cholelithiasis
• Choledocholithiasis
• Gallbladder calcification
• Biliary colic and Biliary
pancreatitis
• Biliary dyskinesia,
• Gallbladder cancer
CONTRAINDICATIONS
Relative:-
Cirrhosis,Portal HTN
Coagulopathy
Suspected malignancy
 Dense intra-abdominal
adhesions
ANESTHESIA:
GA

5. • Position: Patient & Surgeon
 Patient in supine position.
 Head end up and Right side up
The surgeon patient’s left side
 First assistant patient’s right side.
 Second assistant (camera
holder)patient’s left side below the
surgeon.

6. • Creating Pneumoperitoneum:
CO2 Auto-insuffalator

7.  10mm port-In Umblicus to pass
telescope,angled to 30
 5mm or 10 mm-
• Subxiphoid area as working channel
 5 mm port at right subcostal area

9. The patient is placed in reverse
Trendelburg position slightly rotated
to the left .
Advantage- Exposes the fundus of GB ,which is
retracted towards the right liac fossa

10. • Gallbladder retraction (to open up and
expose HC triangle in preparation for next
step)
•Dissection in the Calot’s triangle to achieve
the CVS
•Clipping and division of the cystic duct and
the cystic artery
•Dissection of the gallbladder from its bed

15. The Gall bladder is separated from the liver bed
for about 2 cm to allow the confirmation of the anatomy
Elephant head appearance

16. Cystic duct

18. • Retrograde removal of GB from GB bed and hemostasis of GB bed

19. • Extraction of Gall Bladder

20. • Closure of Primary port Incision:

22. Advantages
•Small,non muscle splitting
incisions
•Decreased blood loss,
•less peritoneal pain and ileus
•Shorter hospitalization
•Lesser wound complication like
wound dehiscence and infection
Disadvantages
•Long learning curve for surgeon
•Narrowed two dimensional
visual field
•High cost of equipment

23. Some related Data
 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
• Haemorrhage
•Bile leak
•Bile duct injury
•Failure to recocnize aberrant
anatomy

24. •Inability to define relevant billiary and vascular anatomy
•Suspected injury to billiary tree
•Suspicion of gall bladder cancer
•Patient intolerance to pneumoperitoneum

25.  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

26. •GOLD STANDARD surgery for gall bladder- Laparoscpic Cholecystectomy
•A surgeon makes the decision to choose the best technique.In any
doubt,consult with seniors.
•Principles include Controlled dissection,Adequate exposure,Controlled
bleeding,Avoiding organ injury
•It’s important to recocnize the complications early
•Recent advancement in guidelines,instruments and techniques makes the
whole procedure easier with less complication