Laparoscopic Cholecystectomy
Date of Surgery -
Preop Diagnosis - cholecystitis and incarcerated umbilical hernia
Postop Diagnosis - same
Surgeon - Dr. Luk/Dr. Tran
Anesthesia - GETA
Blood Loss - Minimal
Complication - None
Findings - cholecystitis and umbilical hernia
Specimens -
Gallbladder
Umbilical Hernia Content
Procedure Performed-
1) Laparoscopic Cholecystectomy
2) Umbilical Hernia Repair
Patient comes in with the above diagnosis and was consented for the above procedures. Risks, benefits, and alternatives were discussed with patient, which includes, but are not limited to, postoperative or chronic pain, bleeding, wound infection, hematoma, bile duct injury, bile leak, injury to other organs, or need for further procedures or workup. Other Complications may include deep vein thrombosis(blood clots), as well as other side effects affecting other organ systems such as the heart or lungs, and in rare circumstances, death as a result of the above complications. The patient understand and agrees to proceed with the proposed procedure.
The Patient was given preoperative antibiotics.
After consent was obtained, the patient was brought to the OR and underwent general anesthesia. The patient was prep and draped in the standard manner.
Timeout was performed and all was in agreement.
Cholecystectomy
A small incision was made at the umbilicus using the number 11 blade. Dissection was carried down to the fascia using the retractors. Once the fascia was opened, a trocar was placed into the abdomen. Next, CO2 gas was used to insufflate the abdomen. The pt was placed into position.
Next, three additional incisions were made and trocars were placed the abdominal cavity. These were placed in the standard locations for laparoscopic cholecystectomy.
The gallbladder was identified. Both the cystic duct and the cystic arteries were identified clearly. They were skeletonized using the laparoscopic dissector. Finally, when they were both clearly visualized and skeletonized, surgical clips were placed on them. Two on the staying side of each and one on the side of the gallbladder.
Once this was done, the cystic duct and cystic artery were cut using laparoscopic scissors. The gallbladder was meticulously dissected off of the liver using the electrocautery instrument. Care was taken to control any bleeding in the liver bed.
Once the gallbladder was removed, it was placed in a laparoscopic retrieval bag. I examined the liver bed and the gallbladder fossa to be sure hemostasis was completely obtained.
Finally, the gallbladder was removed from the abdominal cavity through the umbilical trocar site. C02 was released from the abdominal cavity and the trocars were then removed.
Umbilical Hernia Repair:
The patient also has a umbilical hernia.
A number 10 scalpel was used to extend the umbilical incision to include the hernia. Dissection down to the fascia was performed using electrocautery. The patient had a small umbilical hernia. The omentum that was in the hernia was removed used electrocautery. The Sac was trimmed. The defect was over sewn and repaired using interrupted permanent suture. The wound was then irrigated.
Instruments, sponges, and needle counts were carried out. When this was reported to me as correct, then the skin incisions were closed using absorbable sutures.
The pt tolerated the procedure well and was transferred to the recovery room in stable and satisfactory conditions.