Cholecystectomy

Laparoscopic Cholecystectomy

1. indications

   • asdf

2. positioning

   • asdf

3. essential steps

   • retract effectively to develop hepatocystic triangle

     1. retract fundus superolaterally

     2. retract infundibulum laterally

     3. +/- decompress a distended GB

   • dissect posterior leaf of peritoneum covering GB neck

   • maintain plane of dissection on GB surface

   • create critical view of safety

     1. hepatocystic triangle dissected free of all tissue

        • common hepatic duct

        • inferior liver surface

        • cystic duct

     2. lower 1/3rd GB dissected 30° off cystic plate

     3. two (and only two) structures remain attached to GB

   • +/- cholangiogram w/wo CBDE

   • clip and transect cystic duct & artery

   • dissect GB off liver

4. bailouts

   • open conversion

   • subtotal cholecystectomy: either

     1. fenestrating: GB is opened and cystic duct is closed

     2. reconstituting: remnant GB wall is closed

   • fundus-first cholecystectomy

5. complications

   • TBD

6. dictation

   • TBD

Open Cholecystectomy

1. TBD