Laparoscopic cholecystectomy/ operative surgery

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

1. LAPAROSCOPIC CHOLECYSTECTOMY DR.B.Selvaraj MS; Mch ; FICS; “ Surgical Educator” Malaysia OPERATIVE SURGERY

2. LAPAROSCOPIC CHOLECYSTECTOMY INDICATIONS: Symptomatic Cholelithiasis Porcelain Gall bladder Biliary dyskinesia & Acalculous cholecystitis CONTRAINDICATIONS Suspected malignancy Dense intra-abdominal adhesions ANESTHESIA: GA/ETT POSITION: Supine- consider Xray table for IOC Informed consent- risks of surgery: Bile leak- biliary fistula 0.5% Peritonitis 0.1% Missed stone 1% Injury to bile duct 0.5% Injury to liver, duodenum or colon 0.1% Vascular injuries to portal vein or hepatic artery 0.1% Abscess 0.2% Conversion to open surgery if there are dense adhesions

3. LAPARASCOPIC CHOLECYSTECTOMY Position: Patient & Surgeon Patient in supine position. Both arms can be tucked, or only the left arm can be tucked. The surgeon  patient’s left side F irst assistant  patient’s right side. S econd assistant (camera holder)  patient’s left side below the surgeon.

4. LAPAROSCOPIC CHOLECYSTECTOMY Creating Pneumoperitoneum : Closed or Veress needle method Open or Hasson’s cannula method CO2 Auto- insuffalator

5. LAPAROSCOPIC CHOLECYSTECTOMY Port placement Primary: Umbilicus- 10mm port- laparoscopic telescope 30* angled Secondary: 5mm ports - Epigastric- 5mm or 10 mm- operating port - Rt subcostal medial- 5mm port- dynamic retractor - Rt subcostal lateral- 5mmport- static retractor Introduce secondary trocars under laparoscopic vision

6. LAPAROSCOPIC CHOLECYSTECTOMY Dissection of Calot’s triangle Flagging of infundibulum Incising peritoneal covering anteriorly and posteriorly Rouviere’s sulcus

7. LAPAROSCOPIC CHOLECYSTECTOMY Skeletonising cystic duct & cystic artery Critical view of safety Elephant head appearance

8. LAPAROSCOPIC CHOLECYSTECTOMY For Intraoperative Cholangiogram

9. LAPAROSCOPIC CHOLECYSTECTOMY Clipping & dividing Cystic duct

10. LAPAROSCOPIC CHOLECYSTECTOMY Clipping & dividing Cystic artery

11. LAPAROSCOPIC CHOLECYSTECTOMY Retrograde removal of GB from GB bed and hemostasis of GB bed

12. LAPAROSCOPIC CHOLECYSTECTOMY Extraction of Gall Bladder

13. LAPAROSCOPIC CHOLECYSTECTOMY Closure of Primary port Incision: Post operative care Remove NGT on day of surgery and drain if any on POD # 2 or 3 Diet: Allow liquids after few hours and then advance quickly Ambulate the patient immediately Post operative incentive spirometry or breathing exercises Time off work: 3 to 7 days

14. LAPAROSCOPIC CHOLECYSTECTOMY

15. THANK YOU