Laparoscopic cholecystectomy for acute cholecystitis

This video demonstrates the surgical approach to performing a laparoscopic cholecystectomy in a patient with acute cholecystitis. The surgeon uses a French approach standing between patients legs and trocar positioning. The Calot's triangle is dissected with hook cautery and the cystic duct and artery are identified, clipped and divided. The gallbladder is then dissected off the liver.

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Laparoscopic cholecystectomy for acute cholecystitis

Authors

D Mutter, J Marescaux

Abstract

This video demonstrates the surgical approach to performing a laparoscopic cholecystectomy in a patient with acute cholecystitis. The surgeon uses a French approach standing between patients legs and trocar positioning. The Calot's triangle is dissected with hook cautery and the cystic duct and artery are identified, clipped and divided. The gallbladder is then dissected off the liver.

Classification

routine cases

Keywords

cholecystectomy,operation,Calot's triangle,cystic artery,cystic duct,cholecystitis

Media type

Surgical video

Duration

06'00''

Publication

2003-01

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E-publication

WeBSurg.com, Jan 2003;3(01).
URL: http://www.websurg.com/doi-vd01en1373e.htm

Laparoscopic cholecystectomy for acute cholecystitis

1. Positioning and trocars 00'17''

The patient is placed in a lithotomy position with the left arm tucked along the body. The surgeon stands between the legs and the assistant stands to the left of the patient. Trocar A is the optical trocar, B and C are the operating trocars, and trocar D, the retracting trocar.

2. Exposure of the gallbladder 00'48''

The retracting instrument is inserted through trocar D and helps to lift the gallbladder anteriorly. Adhesions between the omentum and the gallbladder are dissected free. The wall of the gallbladder shows inflammation. We are in the presence of an acute cholecystitis. The adhesions between the omentum and the gallbladder are slowly and gently dissected free using the hook and monopolar coagulation. Care is taken to achieve simultaneous hemostasis. During this dissection, the assistant gently retracts the gallbladder anteriorly and superiorly.

3. Dissection of Calot\\'s triangle 01'57''

The rest of the adhesions are gently dissected away and the left hand gently grasps Hartmann’s pouch. This helps to retract Hartmann’s pouch to the left and to the right to achieve the right amount of tension and to perform the dissection with the right hand. The peritoneal layer of the gallbladder is gently incised and dissected. The lower third of the attachments between the gallbladder and the liver are gently dissected away to open up the triangle of Calot. When this is done anteriorly and posteriorly, the cystic duct and artery are gently dissected using blunt dissection. The cystic duct and artery are now completely isolated. The cystic artery is clipped twice as well as the cystic duct. These structures are then divided.

4. Cholecystectomy 04'00''

The gallbladder is then retracted laterally and anteriorly to allow for the dissection of the plane between the liver and the gallbladder. A small accessory duct of Luschka is found in the gallbladder bed. It is dissected free. It clearly comes from the liver and goes into the gallbladder. This is clipped and divided. The dissection of the gallbladder bed is continued by dividing the peritoneal layer anteriorly and then the fibrous attachments. The posterior peritoneal layer is also divided. The right amount of traction on the gallbladder as well as the edema helps to divide the attachments between the gallbladder and the liver in the right plane. The assistant maintains the liver in the right position while the surgeon retracts laterally the gallbladder. The gallbladder is placed in a retrieval sac and this sac is closed. The liver bed is checked for hemostasis. The closed suction drain may be left in place. The retrieval sac is then extracted and this concludes the procedure.