Laparoscopic cholecystectomy By Nr. Halliru Kabir Kankara, Modular Theater, Presentation-1.pdf

Laparoscopic cholecystectomy a power point presidentation

1. FEDERAL TEACHING HOSPITAL KATSINA
NURSING SERVICES DEPARTMENT
THEATER COMPLEX
MODULAR THEATER
TOPIC; LAPAROSCOPIC CHOLECYSTECTOMY
PRESENTER
Nr. HALLIRU KABIR KANKARA (Rn, RPon, BNSc, Dip. HRMngt.)
February, 2025

2. Introduction
Laparoscopicsurgeryisaminimallyinvasivesurgical
procedurethatusessmallincisionsandacameratoexamineor
treatorgansintheabdomenorpelvis.It'salsoknownas
"keyholesurgery".
Thehepatobiliarysystemismadeupoftheliver,gallbladder,
andbileducts.It'sresponsibleforproducingandreleasingbile,
whichhelpsdigestfoodandremovewaste.
Laparoscopiccholecystectomy,commonlyreferredtoasalap
chole,involvestheremovalofthegallbladderthrougha
laparoscopicapproach.

3. Anatomical overview of the Hepatobiliary
System
Thehepatobiliarysystemconsistsoftheliver,
gallbladder,andbileducts,whichfunctionistoproduce,
store,andtransportbileessentialfordigestion.
Theliverisdividedintorightandleftlobes,with
intrahepaticbileductscollectingbileanddraininginto
therightandlefthepaticducts(Mooreetal.,2020).
Intrahepaticbileducts:Beginassmallcanaliculi
withintheliverandmergeintolargerducts.

4. HepatobiliarySystem Cont.
Extrahepaticbileducts:Therightandlefthepaticductsmergetoform
thecommonhepaticduct(CHD).Thecysticduct,connectingthe
gallbladdertotheCHD,formsthecommonbileduct(CBD),which
drainsintotheduodenumviatheampullaofVater.(Strasberg&Brunt,
2010).
Gallbladder:Apear-shapedsac(7–10cminlength)locatedonthe
inferiorsurfaceoftheliver.Itstoresandconcentratesbile,whichis
releasedinresponsetocholecystokinin(CCK).
Calot’sTriangle:Avitalanatomicalregionborderedbythecysticduct,
commonhepaticduct,andinferiorliveredge.Itcontainsthecystic
arteryandthelymphnodeofLund,cruciallandmarksduring
cholecystectomy.

5. Diagram Of HepatobiliarySystem
System

6. Definition
Laparoscopiccholecystectomyisthe
minimallyinvasivesurgicalremovalofthe
gallbladder,commonlyperformedtotreat
gallstonesandcholecystitis.Itisthestandard
ofcareduetoitsfasterrecovery,reduced
postoperativepain,andshorterhospitalstay
comparedtoopencholecystectomy.

7. Indications
Symptomatic gallstones (biliary colic)
Acute or chronic cholecystitis
Gallstonepancreatitis
Acalculouscholecystitis
Gallbladder polyps >1 cm

8. Contraindications
AbsoluteContraindications:
Uncorrectedcoagulopathy
Severecardiopulmonarydisease(highsurgicalrisk)
Relativecontraindications:
Previousupperabdominalsurgerywithsevereadhesions
Cirrhosiswithportalhypertension
Suspicionofgallbladdercarcinoma

9. Perioperative Responsibilities
PreoperativeResponsibilities
Verifypatientidentity,surgicalconsent,andNPOstatus,Fastingforat
least6hours
PatientPositioning:SupinewithslightreverseTrendelenburgandlefttilt
Anesthesia:Generalanesthesiawithendotrachealintubation
EnsureProphylacticAntibioticsisgiven:Usuallyasingledoseofa
cephalosporin
NasogastricTube:Occasionallyusedincaseofgastricdistension
Ensurelaparoscopicequipmentisfunctional(Kohnetal.,2014).
Conductasurgicalsafetychecklist(timeoutverification)(Duncan&Riall,
2012).

10. Operating Room (OR) Preparation
Checkthefunctionalityoflaparoscopicequipment(light
source,camera,insufflator).
EnsureCO₂insufflatorissetto12–15mmHg.
Preparetrocars,graspers,clipappliers,suction,
electrocautery.
Haveanendo-bagavailableforgallbladderretrieval.
Ensureabackupopensurgerysetupisreadyincaseof
conversion.

11. Intraoperative Responsibilities
Scrub Nurse Duties:
Maintain sterility and perform proper hand scrubbing.
Arrange instruments on the sterile field based on the surgical sequence.
Pass laparoscopic instruments (graspers, clip applier, electrocautery).
Pass instruments efficiently to the surgeon and assistant.
Ensure proper loading and application of clips on the cystic duct and
artery.
Assist with suturing and closing port sites.
Assist in specimen retrieval (Endo-bag use) (Kohn et al., 2014).

12. Intraoperative Responsibilities Cont.
CirculatingNurseDuties:
EnsureCO₂insufflatorpressureissetto12–15mmHg.
Adjusttablepositioning(reverseTrendelenburgwithlefttilt)
(Strasberg&Brunt,2010).
Conductsurgicaltimeout(confirmpatient,procedure,site,
equipment).
Manageelectrosurgicalunit(ESU)settings(ensure
monopolarorharmonicscalpelissetappropriately).
Documentsurgicalsteps,complications,andspecimen
collection.

13. General Postoperative Responsibilities
A. Immediate Postoperative Care
Monitor for bleeding, bile leak, pain, and nausea.
Educate the patient on wound care, diet, and signs of
complications.
Schedule a follow-up appointment (SAGES, 2023).
Maintain CO₂ insufflation levels.
Monitor patient’s vital signs in collaboration with the anesthetist.
Handle specimen collection (gallbladder to pathology if needed).
Document all intraoperative events, instruments used, and any
complications.

14. General Postoperative Respon. Cont.
Painmanagement:NSAIDsoropioidsif
needed.
Diet:Clearliquidsonthesameday,
progressingtoregulardiet.
Mobilization:Encourageearlyambulation
Monitorforcomplications:Bleeding,
infection,bileleak.

15. B. Patient Education Before Discharge
Teachwoundcare(clean,drydressings,signsof
infection).
Explaindietaryguidelines(avoidfattyfoodsinitially).
Educateonpainmanagement(NSAIDs,
acetaminophen).
Instructonsignsofcomplications(fever,jaundice,
severepain,bloating).
Confirmfollow-upappointmentscheduling.

16. Equipment And Instruments
Equipment:
Diathermy machine
SunctionMachine
Monitor (Laparoscopic tower)
Camera control system
Light source
High flow insufflator
CO2 Cylinder

17. Equipment And Instruments Cont.
Fiberopticlens
Fiberopticcamera
General set:
Sponge holders or Rampley’s
Scarpelor blade
Towel clips
Needle holder
Tooth dissecting forceps

18. Laparoscopic set:
Trocars:Typically4(10mmx1,5mmx3)
VeressNeedleorOpticalTrocar(forinsufflation)
Insufflatorconnectingtube:Tomaintainintra-abdominalpressureat12-15
mmHgCO₂
Laparoscope:30°10mmcamera(sometimes5mm)
Graspers:Marylanddissector,atraumaticgrasper
HookorScissors:Forelectrocauterydissection
ClipApplier:5mmor10mmtitaniumclips(Hem-o-lockclipsinselect
cases)
Suction/IrrigationSystem
Endo-Bag:Forgallbladderretrieval

19. Instruments Sets Comprising Basic And
Laparoscopic Instrument

20. Trocars and Minor Instruments

21. Surgical Steps
Step1:PortPlacement
Firstport:10mmintraumbilicaltrocar(forthecamera)
Secondport:10mmepigastricport(forthemainworking
instrument)
Thirdport:5mmrightmid-clavicularlinebelowthecostalmargin
(forassistantgrasper)
Fourthport:5mmanterioraxillaryline(forliverretractionif
needed)
Step2:CreationofPneumoperitoneum
UsingVeressneedleoropticaltrocar,insufflateCO₂to12-15mmHg

22. Incision And Trocars Insertion Sites

23. Laparoscopic Surgery Ongoing

24. Surgical Steps Cont.
Step 3: Gallbladder Exposure
Elevate the liver using a grasper on the fundus
Grasp the infundibulum of the gallbladder and apply
traction
Step 4: Dissection of Calot’sTriangle
Identify cystic duct, cystic artery, and common bile duct
Dissect peritoneum to expose structures clearly
Use electrocautery(monopolaror bipolar) cautiously

25. Diagram Showing Step 3 And 4

26. Surgical Steps Cont.
Step5:ClipandCuttheCysticDuctandArtery
Applytwoclipsproximallyandonedistallyonthe
cysticductandartery
Dividethecysticductandcysticarterycarefully
Step6:GallbladderDissectionfromtheLiver
Useelectrocauteryorharmonicscalpeltoseparatethe
gallbladderfromtheliverbed
Cauterizesmallbleedingpointsasneeded

27. Diagram Showing Step 5 And 6

28. Surgical Steps Cont.
Step7:GallbladderRetrieval
PlacethegallbladderinanEndo-bag
Extractviaumbilicalport(sometimesepigastricif
needed)
Step8:Irrigation&Hemostasis
Irrigatethegallbladderfossaandcheckforbleedingor
bileleaks
Ensurecompletehemostasis

29. Surgical Steps Cont.
Step9:PortClosure
DeflateCO₂andremovetrocarsunderdirect
vision
Closefascialdefectintheumbilicalport(if
>10mm)withVicrylorPDS
Closeskinwithabsorbablesuturesorstaples

30. Complications
Early Complications
Bleeding (from cystic artery or liver bed)
Bile Leak (from cystic duct stump or bile duct injury)
Infection (port-site infection, intra-abdominal abscess)
CO₂ Embolism (rare but fatal)
Late Complications
Bile duct stricture
Retained stones in CBD
Hernia at port site

31. Special Techniques & Variations
1. Single-Incision Laparoscopic Cholecystectomy (SILC)
Uses one umbilical incision with a multiport device.
Better cosmetics but higher technical difficulty.
2. Robotic-Assisted Cholecystectomy
Enhances precision, used in complex cases.
3. Fundus-First (Retrograde) Approach
Used in difficult gallbladders (severe inflammation or adhesions).
4. Subtotal Cholecystectomy
Performed if Calot’striangle is not safely dissectible.
Leaves part of the gallbladder wall intact.

32. Class base on Port Techniques
Four-portlaparoscopiccholecystectomy:One10-mm
optictrocarandthree5-mmworkingtrocars
Three-portlaparoscopiccholecystectomy:One10-
mmoptictrocarandtwo5-mmworkingtrocars
Two-portlaparoscopiccholecystectomy:Two
incisionsthathouse2–3trocars
Single-incisionlaparoscopiccholecystectomy:All
instrumentsthroughanincisionattheumbilicus

33. Class Base On Anatomical Resection
Subtotalcholecystectomies
Circularexcisionofalargeportionofthe
gallbladder
Longitudinalremovalofalargeportion
ofthegallbladder'svisceralwall
Fundectomy
Wedgeresectionofthegallbladder

34. summary
Laparoscopiccholecystectomyisawidelyperformedprocedure
withexcellentoutcomes.SafedissectionofCalot’striangle,
properclipapplication,andmeticuloustechniquearekeyto
avoidingcomplications.Incomplexcases,alternativetechniques
suchassubtotalcholecystectomyorroboticassistancemaybe
used.
Perioperativenursesareessentialinpreparingthepatient,
assistingduringsurgery,maintainingsterility,ensuringequipment
functionality,andmonitoringpostoperativerecovery.Their
attentiontodetailsignificantlyenhancespatientsafetyand
surgicalsuccess.

35. THANKS FOR LISTINING

36. References
Duncan, C. B., & Riall, T. S. (2012). Evidence-based current surgical practice.
Gastroenterology Clinics of North America, 41(1), 57-78.
https://doi.org/10.1016/j.gtc.2011.12.011
Kohn, J. G., Trivedi, N. N., & Chandra, V. (2014). Techniques for safe laparoscopic
cholecystectomy. Surgical Clinics of North America, 94(2), 233-256.
https://doi.org/10.1016/j.suc.2014.01.001
Moore, K. L., & Dalley, A. F. (2020). Clinically oriented anatomy (8th ed.). WoltersKluwer.
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). (2023).
Guidelines for laparoscopic cholecystectomy. https://www.sages.org/publications/guidelines
Strasberg, S. M., & Brunt, L. M. (2010). Rationale and use of the critical view of safety in
laparoscopic cholecystectomy. Journal of the American College of Surgeons, 211(1), 132-
138. https://doi.org/10.1016/j.jamcollsurg.2010.02.043

37. References cont.
Strasberg, S. M., & Brunt, L. M. (2010). Rationale and Use of the Critical View
of Safety in Laparoscopic Cholecystectomy. Journal of the American College of
Surgeons, 211(1), 132-138.
Duncan, C. B., & Riall, T. S. (2012). Evidence-Based Current Surgical
Practice. Gastroenterology Clinics of North America, 41(1), 57-78.
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
(2023). Guidelines for Laparoscopic Cholecystectomy.