LAPAROSCOPIC CHOLECYSTECTOMY
Dr. Steven Bolton is presenting a case of laparoscopic cholecystectomy.
|
This is a case of a 42 year old male with a previous history of abdominal pain for 6 months. He was admitted to the hospital with nausea but vomiting or fever. An ultrasound study showed gallstones with some thickening of the gallbladder wall. The diagnosis of cholecystitis was made and the patient was scheduled to undergo a laparoscopic cholecystectomy. This picture shows the omentum partially covering the gallbladder in its normal position.
|
Due to significant distention of the gallbladder, a needle is used to drain some bile so grasper clamps can be applied for dissection and manipulation.
|
The Hartmann'a pouch is rectracted laterally and upward, exposing the triangle of Calot where the cystic artery can be identified branching off the right hepatic artery.
|
A short cystic duct is dissected free using a "right angle" clamp.
|
Clips are applied to the cystic duct away from the common bile duct.
|
The cystic duct is transected using scissors.
|
Same technique is used with the cystic artery which is dissected free using a "right angle" clamp and will be divided between clips.
|
Hook electrocautery is used to dissect the gallbladder off the liver bed.
|
The gallbladder is now free and will be placed into a Pleatman sac for retreival.
|
This picture shows the body of the gallbladder, that becomes distended during removal. Caution must be used to avoid rupture while pulling.
|
|
