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Laparoscopic Cholecystectomy steps one by one ( Minimal Access Surgery )

Lap chole steps of operation as mentioned in the video

 

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Preparation

  • GA
  • WHO time out
  • Position supine may need head up and right side up
  • Prophylactic antibiotics if operative cholangiogram, inflamed gall bladder, bile spillage or need for conversion

Ports

  • Ports – umbilical port 10mm open technique for camera
  • 10mm Epigastric port just below the xiphisternum
  • 5mm right upper quadrant mid clavicular just 2cm below the coastal margin
  • 5mm right upper 3cm below and lateral to 3rd port
  • Working ports epigastric and RHQ (3rd port)

Steps

  • Insert grasper via 4th port and retract fundus of the gall bladder superiorly (assistant)
  • Insert Yeohan via 3rd subcostal port and hold Hartmann’s pouch using left hand
  • Dissect peritoneum posteriorly using hook diathermy
  • Dissect peritoneum anteriorly using hook
  • The lower 1/3rd of the gall bladder is separated form the liver to expose the cystic plate
  • This should expose critical view of safety identifying cystic duct and artery
  • Identify structures with out any doubt
  • Clip cystic artery and divide
  • Clip cystic duct and divide
  • Dissect gall bladder off the liver bed and collect in Birt bag
  • Wash out using saline
  • Make sure haemostats is secure
  • Change camera to epigastric port and under direct vision remove gall bladder in Birt bag via the umbilical port
  • Close umbilical fascia using 1/0 vicryl or PDS
  • Infiltrate local anaesthetic
  • Close skin

 

 

 

 

 

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