LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
OPEN CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #opencholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy and Modified Radical Mastectomy.
• In this video today, I have discussed Open Cholecystectomy.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
OPEN CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #opencholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy and Modified Radical Mastectomy.
• In this video today, I have discussed Open Cholecystectomy.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
“Love is like the human appendix. You take it for granted while it's there, but when it's suddenly gone you're forced to endure horrible pain that can only be alleviated through drugs.”
― Reverend Jen,
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
“Love is like the human appendix. You take it for granted while it's there, but when it's suddenly gone you're forced to endure horrible pain that can only be alleviated through drugs.”
― Reverend Jen,
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
The gall bladder is located in the junction of the right ninth costal cartilage and lateral border of the rectus abdominis.
It is a pear shaped sac lying on the inferior surface of the liver in a fossa between the right and quadrate lobes with a capacity of about 30 to 50 mL.
Current Applications of Laparoscopic in GI surgeryPradeep Jain
Dr. Pradeep Jain, Fortis Healthcare Laparoscopic GI, GI Oncology Surgery Department Director, has an extensive and rich experience in gastroenterology surgery. He offers patients accurate diagnoses about their gastroenterology conditions, which might be overlooked by other doctors.
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Prof. Mridul Panditrao's Peri-operative MANAGEMENT OF Patients for LaparoscopyProf. Mridul Panditrao
Prof. Panditrao takes you in the detailed discussion about the historical aspects, problems, altered physiology, preparation of and Anesthetic/ peri-operative management of the patients for various laparoscopic surgical procedures
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY (STUDY OF 50 ...KETAN VAGHOLKAR
Background: Laparoscopic cholecystectomy is a new alternative to the traditional open approach for
treating calculous cholecystitis. It is, therefore, necessary to assess the efficacy of laparoscopic cholecystectomy over the
open cholecystectomy. Objectives: To compare the surgical outcomes of laparoscopic cholecystectomy with those of open
cholecystectomy. Materials and methods: 50 patients diagnosed as symptomatic cholelithiasis proven by radiological
investigations were distributed into two groups of 25 each. Group A patients were subjected to laparoscopic cholecystectomy, and group B patients underwent open cholecystectomy. The surgical outcomes were studied prospectively.
Intraoperative complications and postoperative care parameters were evaluated. Results: Mean age of patients in group
A was 46.68±13.6 years, and in the group, B was 42.64±14.1 years. Majority of patients were in the age group of 41 to 60
years. Patients who had diabetes in group B developed wound infections, whereas diabetic patients in group A did not
develop any infection. Significant bleeding necessitating blood transfusion occurred in one patient belonging to group B.
The duration of postoperative analgesia required was 3.16 days in group A and 5.16 days in group B. The duration of
postoperative antibiotics administered in laparoscopic and open cases was 1.48 and 4.8 days, respectively. One of the
patients in group A developed a postoperative biliary leak, whereas none in group B had any such complication. The
commencement of oral feeds and after that return of bowel movements was earlier in group A than group B. The mean
hospital stay was 4.5 days in group A as compared to 6.3 days in group B. Conclusion: Laparoscopic cholecystectomy
is superior to open cholecystectomy regarding reduced postoperative discomfort and pain, antibiotic and analgesic
requirement, early commencement of oral feeds, and shorter duration of hospitalization
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Over the last two decades, laparoscopic cholecystectomy
has replaced open cholecystectomy as the standard surgical procedure for majority of patients of gall stone disease. Till 1999, laparoscopic Cholecystectomy was being performed using multiple ports usually 3 or 4 ports.
Intensive desire of surgeon to reduce the number of ports led invention of two port cholecystectomy and then finally
single incision laparoscopic cholecystectomy (SILC) .
Information about Inflammatory Bowel Disease by Dr Dhaval Mangukiya.
Details of brief overview of the talk, Surgery in crohn's disease, Scenarios, Localised ileal or ileocaecal disease, Coincidental ileitis, Localised or multifocal colonic disease, Concomitant abscess, Surgical considerations, Anastomotic technique, Laparoscopy etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Laparoscopic surgery has undergone rapid development in recent years. Laparoscopic cholecystectomy was first performed in 1985. Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery.
Comments Excellent paper. It’s obvious that you put quite a bit of .docxdrandy1
Comments: Excellent paper. It’s obvious that you put quite a bit of work into this. Unfortunately, your paper needs adequate citations in the body of the text to meet our standards on plagiarism. You need to cite each textbook from your bibliography whenever you quote or use some information from the textbook or other resource. For example, writing (Jones 285) after the quote or information used means that you got it from the book whose author was Jones and the info came from page 285.
Laparoscopic cholecystectomy is a procedure in which laparoscopic techniques remove the gallbladder. It is the standard of care for symptomatic gallbladder disease, of which most are performed for symptomatic cholelithiasis. Other indications include acute cholecystitis, biliary dyskinesia, and gallstone pancreatitis.
Describe the reasons a patient might have the selected surgical procedure
The typical reason a cholecystectomy is a treatment of choice is inflammatory changes of gallbladder or blockage of bile flow by gallstones. Symptomatic cholelithiasis is the most common reason where gallstones in the gallbladder are blocking the bile flow and cause inflammation. The patient usually complains of episodic epigastric pain and right upper quadrant pain that radiates to the right shoulder. This pain is found to occur several hours after heavy meals and the patient experiences nausea, vomiting, bloating, fever, and right upper quadrant tenderness. Another condition is acute cholecystitis, where inflammation and symptoms are more prominent. The patient may have a fever, constant pain, positive Murphy's sign, or leukocytosis. Acute cholecystitis may be caused by calculous biliary tract disease with confirmed gallstones in the abdominal US. Acute acalculous cholecystitis usually occurs in critically ill patients, those with prolonged total parenteral nutrition, and some immunosuppressed patients. Patients with episodes of right upper quadrant pain (which are ‘classic' for biliary pain without evidence of cholelithiasis of US or ERCP) may also be referred for laparoscopic cholecystectomy. Gallstone pancreatitis (when small stones pass through the cystic duct) confirmed by cholangiography is another indication for laparoscopic cholecystectomy.
Describe the reasons a patient might be disqualified for this surgery and the options for the patient if any
A patient might be excluded for laparoscopic cholecystectomy due to acute general conditions that are a contraindication for any surgery such as an acute cardiac failure, uncontrolled hypertension, acute renal failure, pneumonia, etc. The condition should be treated by a primary care provider or specialist and the patient should be stable prior surgery. Additional contraindications may include the inability to tolerate general anesthesia, significant portal hypertension, uncorrectable coagulopathy, and multiple prior operations.
List the diagnostic tests and lab work that an attending surgeon might order and desc.
Similar to Open Vs Laparoscopic cholecystectomy (20)
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. Complete Surgical Removal of Gallbladder
Most commonest abdominal surgery
First described by Langenbuch in 1882
First endoscopic cholecystectomy was performed by
Mühe of Böblingen, Germany in 1985
The National Institutes of Health (NIH)
Consensus Development Conference in 1992
recognized Laproscopic Cholecystectomy as the
new "gold standard" for the treatment of
gallstone disease
4. Anatomy
Classic anatomy of the biliary tree is present in
only 30%
Anomalies are the rule, not the exception
Calot's triangle
Boundaries
Cystic duct,
Cystic artery, and
The common hepatic duct
5.
6. Indications
Chronic Cholecystitis.
Cholelethiasis.
Acute on Chronic Cholecystitis.
Acute Cholecystitis with complications.
Empyema Gallbladder.
Gangrenous Gallbladder.
Perforated Gallbladder.
Trauma to Gallbladder.
Choledocholesthiasis.
As a part of other procedure like Whipple Procedure.
Carcinoma Gallbladder.
Direct Invasion of Hepato-cellular carcinoma.
Metastasis to gall bladder.
Prophylactic Cholecystectomy in high risk patients.
Parasitic Infestation of Gallbladder like in Ascariasis.
In Bariatric surgery
7. Preoperative Considerations:
Consent
Nil by mouth for 8 hrs.
Intravenous Fluids.
Prophylactic Broad Spectrum Antibiotics.
Anaesthesia fitness for General Anaesthesia
especially with related to respiratory function.
Control of Hypertension & DM in affected patients.
Arrangement of 1-2 pints of cross-matched blood.
Correction of Any bleeding or clotting disorder.
8. Open Cholecystectomy
Right subcostal (Kocher) incision
Midline or Paramedian incision
Placement of Retractors and
abdominal Sponges
Adhesions of omentum or viscera
adjacent to the gallbladder are
divided
Fundus held by a sponge holder and
retracted towards surgeon
Dissection to identify cystic duct, its
entry into the common bile duct, and
the cystic artery
9. Dissection in Calot’s Triangle
Ligation of the cystic duct in close proximity to
its junction with the common bile duct has long
been considered an essential component of OC.
For preventing poscholecystectomy syndrome
The cystic artery should be dissected, secured,
and divided near the surface of the gallbladder
Intraoperative cholangiography
Drains are not mandatory
10.
11.
12. After adequate Hemostasis & removal of
abdominal packs closure of posterior rectus
sheath with absorbable sutures.
Anterior Rectus Sheath is closed in continuous
fashion by Non-Absorbable sutures.
Skin closed
13. Postoperative Management
Nil by mouth till bowl sounds are present.
Continue Intravenous fluids till patient is oral free.
Adequate Analgesia.
Continue Intravenous Antibiotics for 72 hours and then change
to oral for one week.
Change of dressing if soaked early otherwise after 72 hours.
Removal of drain when drainage is minimal.
Removal of Sutures when wound is healed.
Anti-ulcer therapy if needed.
DVT Prophylaxis.
Send specimen for Histopathology and stones for chemical
Analysis if present.
14. Laproscopic Cholecystectomy
Traditional approach is 4 port but SILS
has become available as well now a days.
Has become a gold standard approach for
gallbladder removal.
If fails then convert to Open Procedure.
Difficult to perform in Patients with
Previous open Abdominal Surgeries.
Carries some increased risk of extra-
hepatic duct injuries.
Recovery is better and early than open
surgery.
Needs specialized equipment & training
of personnel.
Usually avoided in cases of suspected
malignant Disease.
15. Infundibulum is grasped, placing traction on the
gallbladder in a lateral direction to disalign the cystic
duct and common bile duct (CBD)
Identify the structures forming the sides of Calot's
triangle
Infundibulum of the gallbladder given traction
superior and medial direction
Unnecessary and potentially harmful to dissect the
cystic duct down to its junction with the CBD
The neck of the gallbladder is thus dissected away
from its liver bed, leaving only two structures
entering the gallbladder—the cystic duct and artery
Both cystic duct and cystic artery are divided
between metal clips
Intraoperative cholangiography (IOC)
Dissection is done from infundibulum to fundus
Gall bllader is extracted from one of larger port
16.
17. Advantages and Disadvantages
Advantages Disadvantages
Less pain
Smaller incisions
Better cosmesis
Shorter hospitalization
Earlier return to full
activity
Decreased total costs
Lack of depth perception
View controlled by camera
operator
More difficult to control
hemorrhage
Decreased tactile
discrimination (haptics)
Potential CO2 insufflation
complications
Adhesions/inflammation limit
use
Slight increase in bile duct
injuries
19. Randomized clinical trial of open versus laparoscopic
cholecystectomy in the treatment of acute cholecystitis
By M. Johansson1,*, A. Thune1, L. Nelvin1, M.
Stiernstam1, B. Westman2 andL. Lundell2
Published on 6 DEC 2004 in British Journal of Surgery
Background:
The aim of this prospective trial was to determine whether
surgical approach (open versus laparoscopic) had an impact
on morbidity and postoperative recovery after
cholecystectomy for acute cholecystitis.
Methods:
Seventy patients who met the criteria for acute
cholecystitis were randomized to open or laparoscopic
cholecystectomy. The type of operation was unknown to
the patient and all hospital staff involved in the
postoperative care.
20. Results:
There were no significant differences in rate of
postoperative complications, pain score at discharge and
sick leave.
In eight patients a laparoscopic procedure was converted
to open cholecystectomy.
Median operating time was 90 (range 30–155) and 80
(range 50–170) min in the laparoscopic and open groups
respectively (P = 0·040).
The direct medical costs were equivalent in the two groups.
Although median postoperative hospital stay was 2 days in
each group, it was significantly shorter in the laparoscopic
group (P = 0·011).
Conclusion:
Cholecystectomy for acute cholecystitis can be performed
by either laparoscopic or open techniques without any
major clinically relevant differences in postoperative
outcome. Both techniques offer low morbidity and rapid
postoperative recovery
21. A population-based cohort study comparing
laparoscopic cholecystectomy and open
cholecystectomy
By Steven L Zacks MD, MPH1, Robert S Sandler MD,
MPH1,3, Robert Rutledge MD2 and Robert
S Brown Jr MD, MPH
In The American Journal of Gastroenterology (2002)
OBJECTIVES:
Laparoscopic cholecystectomy (LC) has become a
popular alternative to open cholecystectomy (OC).
Previous studies comparing outcomes in LC and OC
used small selected cohorts of patients and did not
control for comorbid conditions that might affect
outcome. The aims of this study were to characterize
the morbidity, mortality, and costs of LC and OC in a
large unselected cohort of patients.
22. METHODS:
We used the population-based North Carolina Discharge
Abstract Database (NCHDAD) for January 1, 1991, to
September 30, 1994 (n = 850,000) to identify patients
undergoing OC and LC
Compared length of stay, hospital charges, complications,
morbidity, and mortality between OC and LC patients
RESULTS
The OC patients had longer hospitalizations, generated
more charges required home care more often
CONCLUSIONS:
The introduction of LC has resulted in a change in the
management of cholecystitis. Despite a higher proportion
of patients with acute cholecystitis, the risk of dying was
significantly less in LC than in OC patients, even after
controlling for age and comorbidity. Based on lower costs
and better outcomes, LC seems to be the treatment of
choice for acute and chronic cholecystitis
23. Thirty-day complications after laparoscopic or open
cholecystectomy: a population-based cohort study in Italy
By Nera Agabiti1, Massimo Stafoggia1, Marina Davoli1, Danilo
Fusco1, Anna Patrizia Barone1, Carlo Alberto Perucci2
Published in BMJ open in 2013
Objective
The objective of the study is to evaluate short-term
complications after laparoscopic (LC) or open cholecystectomy
(OC) in patients with gallstones by using linked hospital discharge
data.
Design
Population-based cohort study.
Setting
Data were obtained from the Regional Hospital Discharge
Registry Lazio Region in Central Italy (around 5 million
inhabitants) in 2007–2008
24. Outcome measures
30-day surgical-related complications’ defined as any
complication of the biliary tract
30-day systemic complications’
Results
13 651 patients were included; 86.1% had LC, 13.9% OC.
2.0% experienced surgical-related complications (SRC),
2.1% systemic complications (SC).
In relation to SRC, the advantage of LC was consistent
across age categories, severity of gallstones and previous
upper abdominal surgery
No advantage among people with emergency admission and
very old people
Conclusions
This large observational study confirms that LC is more
effective than OC with respect to 30-day complications.
Population-based linkage of administrative datasets can
enlarge evidence of treatment benefits in clinical practice
25. Role of antibiotics on surgical site infection in
cases of open and laparoscopic cholecystectomy:
A comparative observational study
By Pankaj Gharde1, Manish Swarnkar1,
Lalitbhushan S Waghmare2, Vijay Manohar
Bhagat3, Dilip S Gode4, Dhirendra D Wagh1,
Pramita Muntode3, Hrituraj Rohariya1, Anoop
Sharma1
In Journal of Surgical technique and Case report in 2014
Aims and Objectives:
To study the effect of antibiotics on superficial
SSI in the cases of open and laparoscopic
cholecystectomy.
26. Results
2 cases got SSI in LC group and 2 cases got SSI
in OC group
Discussion
Antibiotic prophylaxis has no role in SSI, even if
you provide antibiotics for longer duration they do
not assist in the prevention of infection
Conclusion
Our study concludes that there is no difference
in outcome of patients in the cases of
laparoscopic and open cholecystectomy whether
you give antibiotics or not. The SSI rate remains
the same.
27. Laparoscopic cholecystectomy after a quarter
century: why do we still convert?
By Balazs I. Lengyel, Dan Azagury, Oliver Varban,
Maria T. Panizales, Jill Steinberg, David C. Brooks,
Stanley W. Ashley, Ali Tavakkolizadeh
In Surgical Endoscopy February 2012
Background
Laparoscopic cholecystectomy (LC) is the gold
standard procedure for gallbladder removal. However,
conversion to open surgery is sometimes needed
this study aimed to identify the main reasons for
conversion and ultimately to develop guidelines to help
reduce the conversion rates
28. Methods
Using the National Surgical Quality Improvement Program
(NSQIP) database and financial records, the authors
retrospectively reviewed 1,193 cholecystectomies performed at
their institution from 2002 to 2009 and identified 70
conversions.
Results
In 91% of conversion cases, the conversion was elective. In 49%
of these conversions, the number of ports was fewer than four
Of the six emergent conversions (9%), bleeding and concern
about common bile duct (CBD) injury were the main reasons. One
CBD injury occurred
Conclusions
In 49% of the cases, conversion was performed without a
genuine attempt at laparoscopic dissection. Considering this new
insight into the circumstances of conversion, the authors
recommend that surgeons make a genuine effort at a
laparoscopic approach, as reflected by placing four ports and
trying to elevate the gallbladder before converting a case to an
open approach.
29. Bile duct injuries during open and laparoscopic
cholecystectomy in the laparoscopic era:
alarming trends
By Jukka Karvonen, Paulina Salminen, Juha M.
Grönroos
In Surgical Endoscopy in September 2011
Background
After the introduction of laparoscopic
cholecystectomy (LC), scientific discussion and
concern about iatrogenic bile duct injuries (BDIs)
have been limited mostly to BDIs sustained in LC
BDI,s in all cholecystectomies have not been the
center of attention.
30. Results
Altogether 75 BDIs were encountered in a total of 8349
cholecystectomies
Twenty BDIs (15 Amsterdam type A and 5 type B, C, or D)
occurred in the 1616 OCs (incidence rate = 1.24%)
55 (26 type A and 29 type B, C, or D) in the 6733 LCs (incidence
rate = 0.82%)
All the BDIs in the OCs were missed while 11/29 of the major
BDIs in the LCs were detected at the time of surgery
Fifty-four of 59 type A, B, and C BDIs could be treated
endoscopically.
Conclusions
In the laparoscopic era, OC is associated with a high number of
BDIs, if minor BDIs are included. Excluding some major LC BDIs,
BDIs are, as a rule, missed at the time of surgery. More than
90% of Amsterdam types A, B, and C BDIs can be treated
endoscopically, whereas type D BDI remains an absolute
indication for surgery.
31. Single-incision laparoscopic surgery (SILS) vs.
conventional multiport cholecystectomy: systematic
review and meta-analysis
By S. R. Markar, A. Karthikesalingam, S. Thrumurthy,
L. Muirhead, J. Kinross, P. Paraskeva
In Surgical Endoscopy May 2012
Background
Single-incision laparoscopic surgery (SILS) has gained
increasing attention due to the potential to maximize
the benefits of laparoscopic surgery.
The aim of this systematic review and pooled analysis
was to compare clinical outcome following SILS and
standard multiport laparoscopic cholecystectomy for
the treatment of gallstone-related disease
32. Results
In total, 375 cholecystectomy operations from 7 randomised
controlled trials were included, 195 by single-incision (SILS) and
180 by conventional multiport
Operating time was significantly longer in the SILS group
compared to the standard multiport laparoscopic
cholecystectomy group
There was no significant difference in the incidence of
postoperative complications, postoperative pain score (VAS), or
the length of hospital stay between the two groups.
Conclusion
The results of this meta-analysis demonstrate that single-
incision laparoscopic cholecystectomy is a safe procedure for the
treatment of uncomplicated gallstone disease, with postoperative
outcome similar to that of standard multiport laparoscopic
cholecystectomy. Future high-powered randomized studies
should be focused on elucidating subtle differences in
postoperative complications, reported postoperative pain, and
cosmesis following SILS cholecystectomy in more severe biliary
disease.
33. Comparison
Open Cholecystectomy Laparoscopic Cholecystectomy
Easy.
Can be done in peripheral
centers.
May have more post operative
respiratory complications.
Cosmetically not good.
Hospital Stay is longer.
Usually Reserved for failed
laparoscopic cases &
malignant Disease.
Needs special equipment &
training of personnel.
Learning Curve & Good Hand
eye coordination needed.
Cost is higher.
Hospital stay is shorter.
Lesser post operative
complications.
Avoided in Malignant Disease.
If fails then have to proceed
towards open approach.
Has become Gold standard
treatment for Gall bladder