Lap Chole Requiring GIA
Date of Surgery -
Preop Diagnosis -
Postop Diagnosis - same
Surgeon - Dr. Luk / Dr. Tran
Assistant Surgeon -
Anesthesia - General Anesthesia
Blood Loss - Minimal
Complication - None
Findings -
Specimens -
Procedure Performed- Laparoscopic Cholecystecomy
Description of Procedure:
The proposed procedure was discussed with the patient along with alternatives. All risks and benefits were explained to the patient and he/she agreed to the procedure.
Standard 4 port laparoscopic incisions were created using a #11 scalpel. The trocars were placed either through the open technique, or through direct vision. Carbon dioxide was used to insufflate the abdominal cavity. The gallbladder was identified.
The gallbladder itself was severely inflamed with adhesions around he infundibulum indicating chronic inflammation.
The atraumatic grasper was used to elevate the gallbladder towards the head.
The infundibulum was retracted in the lateral direction. Electrocautery was used to carefully skeletonize the area around the cystic duct and cystic artery.
There were too much adhesion to do this safely so the gallbladder was then taken down from it's dome.
The electrocautery was used to taken gallbladder down from the liver bed
Once the neck was reached, I felt that the region of the cystic duct and artery was too inflamed for safe dissection and the standard clip will not be suitable for proper sealing of the cystic duct.
The GIA stapler was used to divide the GB neck and cystic duct . The gallbladder was then removed from the gallbladder bed using electrocautery. The gallbladder was removed from the abdominal cavity using laparoscopic retrieval bag. Suction irrigation was used wash out the area around the liver bed. Hemostasis was obtained using electrocautery.
Once hemostasis was completely obtained, then the carbon dioxide was released from the abdominal cavity. Trocars were removed.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
The umbilical fascia was closed using a 0-Prolene suture. All skin incisions were closed using absorbable stitch.
The patient tolerated the procedure well and was transferred to the recovery room in stable and satisfactory condition