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GENERAL OBJECTIVES
By the successful completion of the course, BSN 4S-A nursing students will know more about
Laparoscopic Cholecystectomy Procedure and will be able to produce synthesis based on real
circumstances.
To gain essential practical experience, knowledge, and skills in providing effective nursing care and
support during a laparoscopic cholecystectomy procedure.
This case study also aims to cultivate well rounded nursing students who can deliver safe, effective,
and compassionate care in the area.
SPECIFIC OBJECTIVES:
Patient Assessment:
 To verify patient identification, surgical site, and consent in collaboration with the surgical
team.
 To participate in the preoperative assessment of the patient, including reviewing medical
records and conducting a focused physical examination.
 To Document relevant information such as vital signs, allergies, and patient history.
Informed Consent:
 To observe and assist in the informed consent process, ensuring that the patient fully
understands the procedure and its potential risks.
 To verify that the consent form is correctly completed.
Operating room Preparation:
 To assist in preparing the operating room and ensuring all required equipment and
supplies are readily available.
Infection Control and Aseptic Technique:
 To learn and apply strict aseptic techniques to maintain a sterile field throughout the
procedure, the laparoscopic cholecystectomy
 To observe and assist with gowning, gloving, and draping of the patient.
Assisting the Surgical Team:
 To Assist the surgeon and the surgical team throughout the laparoscopic cholecystectomy
by providing the appropriate surgical instrument, patient positioning, trocar placement, and
maintaining a clear view of the operative field; provide appropriate and adequate lighting.
Anesthesia Management:
 To observe the administration of anesthesia and continuously monitor the patient's vital
signs under the guidance of the anesthesiologist.
 To learn to respond appropriately to any changes in the patient's condition.
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Safety and Emergency Preparedness
 To analyze potential complications, such as bleeding or infection that may arise during and
after laparoscopic cholecystectomy and nursing interventions required to address them.
Documentation:
 Practice accurate and timely documentation of vital signs, anesthesia administration, and
any nursing interventions performed during the procedure.
Communication and Teamwork:
 Collaborate with other healthcare professionals to ensure the patient's safety and well-
being before, during and after laparoscopic cholecystectomy.
Postoperative Care:
 Monitor the patient's vital signs continuously after anesthesia

 Provide supplemental oxygen to the patient until he has the ability to breathe on his own
following post-anesthesia.
 Assist in transferring the patient to the post-anesthesia care unit (PACU) and provide basic
postoperative care under supervision, including monitoring for immediate complications.
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OVERVIEW OF THE DISEASE
DEFINITION
- Calculous cholelithiasis refers to the presence of gallstones in the gallbladder. Gallstones are
solid particles that form from bile cholesterol and bilirubin in the gallbladder. Calculous
cholelithiasis can lead to various symptoms, including abdominal pain, nausea, and vomiting.
Treatment options may include lifestyle changes, medications, or, in severe cases, surgical
removal of the gallbladder.
CAUSES
The primary causes include:
 Excess Cholesterol: When there is an imbalance in the substances that make up bile,
particularly high levels of cholesterol, it can lead to the formation of gallstones.
 Bilirubin Imbalance: An excessive amount of bilirubin, a component of bile, can contribute to
gallstone formation. This can occur in conditions like liver cirrhosis or hemolytic anemia.
 Gallbladder Dysfunction: If the gallbladder doesn't empty properly or frequently enough, bile
can become concentrated, increasing the risk of gallstone formation.
 Obesity: Obesity is a significant risk factor for gallstones, likely due to increased cholesterol
levels in the bile and reduced gallbladder emptying.
 Rapid Weight Loss: Losing weight too quickly, whether through dieting or surgery, can lead
to imbalances in bile salts and cholesterol, promoting gallstone formation.
 Pregnancy: Pregnancy increases the risk of gallstones due to hormonal changes that affect
the composition of bile.
 Genetics: A family history of gallstones can increase an individual's susceptibility to
developing them.
 Certain Medical Conditions: Conditions such as diabetes, certain liver diseases, and
Crohn's disease can increase the risk of gallstones.
 Certain Medications: Some medications, like drugs that lower cholesterol levels, can
increase the risk of gallstones.
SIGNS AND SYMPTOMS
 Abdominal Pain: The most common symptom of gallstones is a sudden and intense pain in
the upper right abdomen, often after a fatty meal. This pain, known as biliary colic, can radiate
to the back or right shoulder blade.
 Nausea and Vomiting: Many individuals with gallstones experience nausea and may vomit
due to the pain and discomfort.
 Indigestion: Some people with gallstones may have indigestion, bloating, or an intolerance
for fatty or greasy foods.
 Fever and Jaundice: In some cases, gallstones can lead to inflammation of the gallbladder
(cholecystitis), causing fever, chills, and yellowing of the skin and eyes (jaundice).
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 Changes in Stool and Urine: Gallstones can affect the color of stool, making it lighter in
color, and urine may become darker.
 Intolerance to Certain Foods: Foods high in fat might trigger symptoms or exacerbate
existing pain in individuals with gallstones.
RISK FACTORS
 Age and Gender: Gallstones are more common in older adults and in women, particularly
those who are pregnant, use hormonal contraceptives, or undergo hormone replacement
therapy.
 Obesity: Being overweight or obese increases the risk of gallstone formation, likely due to
higher levels of cholesterol in the bile.
 Rapid Weight Loss: Losing a large amount of weight quickly, such as through bariatric
surgery or crash dieting, can increase the risk of gallstones.
 Diet: Diets high in cholesterol, fat, and low in fiber can contribute to gallstone formation.
 Genetics: A family history of gallstones increases the risk of developing them.
 Medical Conditions: Certain conditions, such as diabetes, cirrhosis of the liver, and certain
blood disorders, can increase the risk of gallstones.
 Gastrointestinal Disorders: Conditions that affect the normal functioning of the digestive
system, such as Crohn's disease and irritable bowel syndrome, can increase the risk of
gallstones.
 Pregnancy: Pregnancy and the use of estrogen-based medications can increase cholesterol
levels in bile and decrease gallbladder movement, increasing the risk of gallstones.
 Lifestyle Factors: Lack of physical activity and sedentary behavior are associated with an
increased risk of gallstones.
 Fasting or Starvation: Prolonged fasting or starvation can lead to imbalances in bile
composition, increasing the risk of gallstones.
 Certain Medications: Some medications, including drugs that lower cholesterol levels and
certain therapies for rapid weight loss, can increase the risk of gallstones.
TREATMENT
 Observation: If gallstones are discovered incidentally and are not causing any symptoms,
they may not require treatment. In such cases, doctors often adopt a wait-and-watch
approach, monitoring for any signs of symptoms or complications.
 Lifestyle Changes: Adopting a healthy lifestyle, including maintaining a balanced diet,
managing weight, and exercising regularly, can help prevent the progression of gallstones.
 Dietary Modifications: Avoiding high-fat and high-cholesterol foods can reduce the
frequency and severity of symptoms, especially if the gallstones are related to diet.
 Medications: Certain medications can be prescribed to dissolve cholesterol gallstones in
some cases. However, this process is often slow and may take months or years. It's not
suitable for everyone and requires careful medical supervision.
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 Surgery (Cholecystectomy): Surgical removal of the gallbladder is the most common and
definitive treatment for symptomatic gallstones. This procedure, known as cholecystectomy,
can be performed through traditional open surgery or minimally invasive laparoscopic surgery.
Laparoscopic surgery typically involves a shorter recovery time and less pain compared to
open surgery.
 Endoscopic Procedures: In some cases, gallstones can be removed from the bile duct
using endoscopic retrograde cholangiopancreatography (ERCP), a procedure that combines
endoscopy and X-ray imaging.
 Extracorporeal Shock Wave Lithotripsy (ESWL): ESWL is a non-invasive procedure that
uses shock waves to break gallstones into smaller pieces, making it easier for the body to
pass them. This method is generally used for specific types of gallstones.
PREVENTION
 Maintain a Healthy Diet: Eat a balanced diet that is low in saturated fats and cholesterol.
Increase your intake of fiber, fruits, vegetables, and whole grains. Avoid rapid weight loss or
crash diets, as they can increase the risk of gallstones.
 Manage Weight: If you are overweight or obese, losing weight gradually through a
combination of healthy eating and regular exercise can lower the risk of gallstones.
 Stay Hydrated: Drink an adequate amount of water daily. Staying well-hydrated can help
prevent the formation of gallstones.
 Regular Physical Activity: Engage in regular physical activity. Aim for at least 150 minutes of
moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week.
 Limit Alcohol Consumption: If you drink alcohol, do so in moderation. Excessive alcohol
intake can increase the risk of gallstones.
 Avoid Rapid Weight Loss: If you need to lose weight, aim for a slow and steady weight loss
of 1-2 pounds per week. Rapid weight loss can increase the risk of gallstone formation.
 Consider Medications: If you are at a high risk of developing gallstones (for example, if you
are undergoing rapid weight loss or have a family history), your healthcare provider might
consider prescribing medications to help dissolve cholesterol gallstones or reduce the risk of
gallstone formation.
 Manage Chronic Conditions: If you have conditions like diabetes or liver diseases, work
with your healthcare provider to manage them effectively, as these conditions can increase
the risk of gallstones.
 Avoid Certain Medications: Some medications, such as hormone replacement therapy,
might increase the risk of gallstones. Discuss the potential risks with your healthcare provider
if you are prescribed such medications.
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OVERVIEW OF THE SURGICAL PROCEDURE
Laparoscopic cholecystectomy is a minimally invasive surgical procedure used to remove the

gallbladder. It's the most common method for treating gallstones and gallbladder-related issues.
 Preparation: Before the surgery, patients typically undergo a thorough evaluation, including
blood tests and imaging studies, to assess their overall health and the extent of gallbladder
disease.
 Anesthesia: Laparoscopic cholecystectomy is performed under general anesthesia, ensuring
the patient is asleep and pain-free during the procedure.
 Small Incisions: Instead of a single large incision used in traditional open surgery,
laparoscopic cholecystectomy involves several small incisions (usually 3 to 4) in the
abdomen. Through these incisions, a laparoscope (a thin, flexible tube with a camera and
light) and surgical instruments are inserted.
 Carbon Dioxide Insufflation: Carbon dioxide gas is pumped into the abdomen to create
space for the surgeon to work. This inflation allows better visualization and manipulation of the
organs.
 Gallbladder Removal: The surgeon carefully examines the gallbladder and surrounding
structures on a video monitor connected to the laparoscope. The gallbladder is then
dissected, detached from the liver, and removed through one of the small incisions.
 Closure: After the gallbladder is removed, the small incisions are closed with stitches or
surgical tape. Often, absorbable stitches are used, eliminating the need for removal later.
 Recovery: Recovery time for laparoscopic cholecystectomy is typically shorter than open
surgery. Patients may go home the same day or after a short hospital stay, depending on the
complexity of the procedure and individual health factors.
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PATIENT’S PROFILE
o Name: Patient AF
o Age: 45 years Old
o Sex: Male
o Date of Birth: May 23, 1978
o Religion: Iglesia ni Cristo
o Civil Status: Married
o Occupation: Government Employee
o Date Admitted: September 25, 2023
o Time of Admission: 7:00 pm
o Admitting Diagnosis: Cholelithiasis
o Final Diagnosis: Calculous Cholelithiasis
o Surgical Procedure: Laparoscopic Cholecystectomy
o Surgeon: Dr. E
o Anesthesiologist: Dr. A
o Anesthesia Used: General Anesthesia
o Operation Started:
Date: September 26, 2023
Time: 9:36 pm
o Operation Finished Time: 10:45 pm
PATIENT’S MEDICAL HISTORY
PAST MEDICAL HISTORY
- The patient had his circumcisions when he was 10 years old through traditional method . He
had previous records of hospitalizations in April 2023 due to acute gastroenteritis and
dehydration. He was confined for two days and discharged. He had a fever, cough, and cold,
but he only takes analgesics as his medication. He has no allergies or asthma. He had flu
vaccines and immunization vaccines. He also had the COVID-19 Pfizer vaccine completed
with two boosters.
PRESENT MEDICAL HISTORY
- In August 2023, the patient reported abdominal pain. He decided to have a checkup that
month, and underwent an ultrasound to see what was the reason for his pain. They found a
clotted thing in his gallbladder, but the patient decided not to comply any procedure because
he's too busy with his work.
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Until September 25, 2023, he felt severe abdominal pain and decided to go for a checkup.
The doctor scheduled the patient for a laboratory test for the preparation of his surgery on
September 26, 2023 at 9:00 in the evening.
SOCIAL/PSYCHOLOGICAL HISTORY
- The patient is a government employee who works at the PhilHealth office at the Quirino
Provincial Medical Center. He is dedicated to his career and works six days a week. He has a
wife and children, is respected in the community, and occasionally goes to gatherings and
activities in the community when he has the time. Although he occasionally drinks, he has
never tried smoking. He regularly attends mass twice a week and actively engages in church
activities at Iglesia ni Cristo. The patient's job is going well, and he has no problems at all. He
provides for the family financially.
SURGICAL HISTORY
- The patient underwent a laparoscopic cholecystectomy on October 26, 2023, at Quirino

Provincial Medical Center due to a calculous cholecystectomy, and his gallbladder was
removed, other than that there is no previous surgery procedures.
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FAMILY HISTORY
FATHER SIDE MOTHER SIDE
HTN HTN
GRANDFATHER GRANDMOTHER GRANDFATHER GRANDMOTHER
HTN HTN HTN
PARENTS
HTN
HTN LEGEND:
MALE
FEMALE
PATIENT
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DIAGNOSTIC PROCEDURE
 Ultrasound: Ultrasound imaging is the most common and effective method for detecting
gallstones. High-frequency sound waves are used to create images of the gallbladder and
identify the presence, size, and location of gallstones. It is non-invasive and painless.
 Blood Tests: Blood tests can be conducted to check for signs of infection, inflammation, or
obstruction of the bile ducts. Elevated levels of liver enzymes or bilirubin may indicate
gallbladder issues.
 CT Scan (Computed Tomography): A CT scan provides detailed cross-sectional images of
the abdomen, helping to identify gallstones and any complications they might have caused,
such as inflammation or infection.
 MRI (Magnetic Resonance Imaging): MRI uses magnetic fields and radio waves to generate
detailed images of the internal organs. It can help in diagnosing gallstones and complications
without exposing the patient to radiation.
 HIDA Scan (Hepatobiliary Iminodiacetic Acid Scan): This is a nuclear imaging test used to
evaluate the function of the gallbladder and detect obstructions in the bile ducts. A radioactive
tracer is injected into the patient's vein, and a special camera is used to track its movement
through the liver and into the gallbladder.
 Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is a procedure used
to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It involves
inserting an endoscope (a thin, flexible tube with a camera) through the mouth, esophagus,
and stomach into the small intestine. Dye is injected into the bile ducts, making them visible
on X-rays.
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ANATOMY OF SURGICAL SITE
The gallbladder is a hollow organ that sits

beneath the liver and stores bile made in the
liver. In adults, the gallbladder measures
approximately eight centimeters (3.1 in) in
length and four centimeters (1.6 in) in diameter
when fully distended.
The gallbladder is divided into three sections:

The fundus, The body, The neck. The neck
tapers and connects to the biliary tree via the
cystic duct, which then joins the common
hepatic duct to become the common bile duct.
At the neck of the gallbladder is a mucosal fold
where gallstones commonly get stuck.
Physiology of the Gallbladder
The gallbladder is a small, pear-shaped organ located beneath the liver, and it plays a crucial role in
the digestive process by storing and concentrating bile. The physiology of the gallbladder involves
several key functions:
 Bile Storage: The primary function of the gallbladder is to store bile, a digestive fluid
produced by the liver. Bile is essential for the digestion and absorption of dietary fats.
 Bile Concentration: While storing bile, the gallbladder also concentrates it by removing water
and electrolytes, making the bile more potent and effective in emulsifying fats.
 Bile Release: When a meal is consumed, especially one high in fat, the gallbladder contracts
and releases the concentrated bile into the duodenum, the first part of the small intestine. This
is triggered by a hormone called cholecystokinin (CCK) released in response to the presence
of fats and proteins in the duodenum.
 Emulsification of Fats: Bile contains bile salts, which act as emulsifying agents. They break
down large fat globules into smaller droplets, increasing the surface area for digestive
enzymes (lipases) to work on the fats. This emulsification process aids in the absorption of
dietary fats.
 Fat Digestion and Absorption: In the presence of bile, pancreatic lipases can efficiently
break down fats into fatty acids and glycerol. These smaller molecules can then be absorbed
through the intestinal wall and transported to the bloodstream for use by the body.
 Recycling of Bile Components: Bile is continually recycled in the body. After aiding in
digestion, some of it is reabsorbed in the small intestine and returned to the liver, where it can
be used again. This process is known as enterohepatic circulation.
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The gallbladder's role in bile storage, concentration, and release is vital for efficient fat digestion and
absorption. However, if the gallbladder is removed due to gallstones or other issues, the body can
still manage to digest fats, but it may be less efficient, especially when consuming large, fatty meals.
Physiology of the Gallbladder with Stones
 Bile Production: The liver continuously

produces bile, which contains bile salts,
cholesterol, bilirubin, and other
substances. Bile salts are essential for
the digestion and absorption of dietary
fats.
 Gallstone Formation: Cholelithiasis
occurs when there is an imbalance in the
constituents of bile, leading to the
precipitation of substances like
cholesterol or bilirubin. These substances
can aggregate and form gallstones.
 Gallstone Types: There are two main
types of gallstones: cholesterol stones
and pigment stones. Cholesterol stones
are the most common and primarily
consist of cholesterol, while pigment
stones are made up of bilirubin.
 Obstruction: Gallstones can obstruct the
flow of bile within the gallbladder or bile
ducts. This obstruction can cause
inflammation, infection, or even lead to
complications like cholecystitis
(inflammation of the gallbladder) or
choledocholithiasis (stones in the common bile duct).
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OR PROCEDURE
Steps involved in a Laparoscopic Cholecystectomy Procedure
The operating room (OR) offers a place for surgeons to

complete surgical procedures safely. Not only is the OR sterile
Preparation of the OR to prevent infection, but it also contains all the equipment the
surgical team needs to perform the procedure and respond
should complications arise.
It is necessary that all surgical / procedural team members

collaborate and communicate to ensure that all accountable
Preparation of
Instruments items are counted and documented within the surgical count
record as part of the surgical procedure to reduce the risk of a
retained item. Maintain sterility of the instruments.
The patient is positioned on the operating table, in a supine
Patient Positioning (lying on the back) position. Ensure proper positioning to

prevent injuries or fall, lock table and put strap if necessary
The patient is placed under general anesthesia to ensure they

are unconscious and pain-free throughout the surgery. The
Anesthesia patient had Fentanyl, Atropine, Rocuronium, Propofol then lastly
is Sevoflurane to help the patient sleep. Ensure patent airway,
watch out for hypotension and hypothermia, continuously
monitor vital sign
Preparation of the The surgical area, typically the upper abdomen, is cleaned and
Abdomen sterilized. Sterile drapes are used to cover the surgical site.
Covered exposed body parts when not in use to prevent heat
loss
Creation of Carbon dioxide gas is introduced into the umbilical cavity

Pneumoperitoneum through a trocar inserted through the umbilicus. This inflates the
abdomen, creating space for the surgical instruments.
.
Several small incisions are made in the abdominal wall.10mm

trocar inserted at umbilical and mid epigastric area and 5 mm
Trocar Insertion
trocar inserted at subcostal area right. Trocars (cannulas) are
inserted through these incisions to provide access for the
laparoscopic instruments.
A laparoscope, which is a long, thin tube with a light and camera

Camera Insertion at the end, is inserted through one of the trocars. This allows the
surgical team to visualize the internal organs on a monitor.
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Exploration of the The surgeon uses the laparoscope to explore the abdominal
Abdominal Cavity cavity, ensuring there are no unexpected adhesions or issues.
Dissection and Additional instruments, such as graspers and scissors, are

Exposure of the inserted through the other trocars. The surgeon carefully
Gallbladder dissects the tissues to expose the gallbladder and its
attachments.
The surgeon identifies the cystic duct and artery, which supply
Clipping or Sealing the
Cystic Duct and Artery the gallbladder. These structures are clipped, cut, or sealed to
prevent bile flow into the gallbladder.
Once the cystic structures are secured, the surgeon carefully

Gallbladder Removal detaches the gallbladder from the liver using electrocautery or
other cutting instruments.
Extraction of the The detached gallbladder is extracted through one of the trocar
Gallbladder incisions.
The surgeon may inspect the common bile duct for stones or
Bile Duct Inspection
other abnormalities.
After confirming there is no bleeding or bile leakage, the trocars

are removed, and the small incisions are closed with sutures or
Closure
surgical staples and dress sterile dressing. Ensure all
instruments and supplies used are counted completely before
completely closing the operation .
0 Drain In some cases, a drain may be placed near the surgical site to
help with fluid drainage.
Monitoring and The patient is gradually awakened from anesthesia, and their
Recovery vital signs are closely monitored. They are then transferred to a
recovery area. Provide oxygen supplemental, continuously
monitor vital signs and report any signs of complications
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INSTRUMENT AND FUNCTIONS
Maryland dissector - is a versatile

instrument used in various ways during a
laparoscopic cholecystectomy procedure, a
surgery performed to remove the
gallbladder.
Here's a breakdown of what, how, where,

why, and when it is used:
What: The Maryland dissector is a laparoscopic instrument featuring a long shaft and a curved,
serrated jaw at the end. It can be equipped with electrocautery capabilities for cutting and
coagulating tissues using electrical energy.
How: The Maryland dissector is used with a combination of gentle pressure and precise movements
to dissect tissues, grasp delicate structures, cut, coagulate, and provide traction during the surgery.
Its curved, fine-tipped jaws allow surgeons to work in confined spaces with accuracy.
Where: The Maryland dissector is used inside the abdominal cavity, accessed through small
incisions made in the patient's abdomen. It is inserted through trocars, which serve as access points
for laparoscopic instruments.
Why: The Maryland dissector is used in laparoscopic cholecystectomy for several reasons:
- Precision: Its fine tips allow precise dissection of tissues and separation of the gallbladder
from surrounding structures.
- Grasping: The instrument can gently grasp tissues, preventing injury to delicate structures and
minimizing trauma.
- Electrocautery: If equipped, it helps in cutting and coagulating tissues, controlling bleeding
during the surgery.
- Traction: Provides controlled traction, aiding in the dissection process.
- Adhesiolysis: Helps in separating adhesions if present, ensuring safe removal of the
gallbladder.
When: The Maryland dissector is used at various stages of the laparoscopic cholecystectomy
procedure, including:
- Exploration: Initially for exploring the abdominal cavity and assessing the gallbladder's
condition.
- Dissection: To dissect the gallbladder from the liver bed, isolate the cystic duct and artery, and
separate adhesions if present.
- Clipping and Cutting: To apply clips on the cystic duct and artery before cutting them, ensuring
secure closure.
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- Hemostasis: If there's bleeding, the dissector can be used for electrocautery to achieve
hemostasis.
- Traction: Throughout the procedure for gentle tissue retraction, providing better visibility and
maneuverability.
Atraumatic Grasper- in a
laparoscopic cholecystectomy, the
atraumatic grasper plays a vital role
in delicately manipulating tissues and
organs, especially around the
gallbladder without causing
unnecessary trauma.
Here's a breakdown of what, how, where, why, and when it is used:
What: An atraumatic grasper is a laparoscopic instrument with a gentle, non-serrated jaw. It is

designed to minimize tissue trauma during manipulation and retraction.
How: The atraumatic grasper, also known as atraumatic forceps, is used in a laparoscopic
cholecystectomy procedure by inserting it through small incisions in the patient's abdomen.
Surgeons utilize it to grasp, hold, and manipulate tissues and organs gently without causing damage
or trauma.
Where: The atraumatic grasper is used inside the abdominal cavity, accessed through trocars (small
tubes inserted through incisions) during laparoscopic cholecystectomy. It operates near the
gallbladder and surrounding structures.
Why: The atraumatic grasper is used for several reasons during laparoscopic cholecystectomy:
- Gentle Grasping: Its design allows surgeons to grasp tissues, such as the gallbladder or
surrounding structures, gently and securely, minimizing the risk of injury.
- Tissue Manipulation: Surgeons use the atraumatic grasper to manipulate tissues, providing
better visibility and access to the surgical area.
- Avoiding Trauma: The atraumatic grasper's non-serrated jaws prevent unnecessary tissue
trauma, making it ideal for delicate structures and minimizing post-operative complications.
When: The atraumatic grasper is typically used throughout the laparoscopic cholecystectomy
procedure. It is employed during the initial exploration, dissection of the gallbladder, manipulation of
surrounding tissues, and other stages where gentle grasping and manipulation are required.
Surgeons may switch between different instruments based on the specific needs of the surgery
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Laparoscopic Metz Scissor – it is
essential tools in laparoscopic
cholecystectomy procedures, allowing
surgeons to make precise cuts on delicate
structures. Their use ensures controlled
dissection, minimizes tissue trauma, and
contributes to the overall success and
safety of the surgery.

What: Laparoscopic Metz scissors are specialized cutting instruments with a curved design and
sharp blades. They are designed for minimally invasive surgeries, allowing surgeons to make precise
cuts while working within limited space.
How: Laparoscopic Metz scissors are utilized in a laparoscopic cholecystectomy procedure by

inserting them through small incisions in the patient's abdomen. Surgeons use these scissors to cut
tissues, including the cystic duct and artery, with precision. The laparoscopic Metz scissors have a
long shaft and curved, fine-tipped blades, allowing for accurate dissection and minimizing tissue
trauma.
Where: Laparoscopic Metz scissors are used inside the abdominal cavity, accessed through trocars
(small tubes inserted through incisions) during laparoscopic cholecystectomy. Surgeons maneuver
these scissors near the gallbladder and surrounding structures to cut tissues with accuracy.
Why: Laparoscopic Metz scissors are used for several reasons in laparoscopic cholecystectomy:
- Precision Cutting: Their fine, curved tips enable surgeons to make precise cuts on delicate
structures like the cystic duct and artery, ensuring accurate dissection.
- Minimized Trauma: By making clean and precise cuts, these scissors reduce tissue trauma,
promoting faster healing and reducing the risk of complications.
- Controlled Dissection: Surgeons can control the dissection process effectively, ensuring that
only targeted tissues are cut while preserving surrounding structures.
When: Laparoscopic Metz scissors are used at specific stages of a laparoscopic cholecystectomy
procedure:
- Cutting Ducts: They are used to cut the cystic duct and artery, which are crucial steps in the
removal of the gallbladder. Proper cutting and closure of these structures prevent bile leakage
after gallbladder removal.
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- Dissection of Adhesions: If there are adhesions (abnormal connections) between the
gallbladder and surrounding tissues, Metz scissors may be used to carefully dissect and
separate these adhesions, ensuring safe removal of the gallbladder.
Autoclavable Camera - enable surgeons

to visualize the surgical site, perform
precise maneuvers, and ensure the safety
and success of the surgery. These cameras
are sterilized through autoclaving for reuse,
providing a cost-effective and reliable
solution for laparoscopic surgeries.

What: An autoclavable camera, also known as a sterilizable or autoclavable endoscope, is a

specialized camera used in laparoscopic surgeries. Unlike traditional endoscopes, autoclavable
cameras are designed to withstand the high temperatures and pressures of autoclaving, a
sterilization process using steam.
How: Autoclavable cameras are used by inserting them into the abdominal cavity through trocars
(small incisions) during a laparoscopic cholecystectomy procedure. They provide high-quality video
feed to the surgical team, enabling visualization of the surgical site on a monitor. After use, these
cameras can be sterilized through autoclaving for reuse in subsequent surgeries.
Where: Autoclavable cameras are used inside the abdominal cavity, providing a direct view of the
surgical area. The camera is connected to a light source and a monitor, allowing the surgical team to
visualize the procedure in real-time.
Why: Autoclavable cameras are used in laparoscopic cholecystectomy and other surgeries for
several reasons:
- Visualization: They provide clear and magnified images of the surgical site, allowing surgeons
to perform precise dissections and manipulations.
- Minimized Infection Risk: Autoclaving ensures that the camera is free from pathogens,
minimizing the risk of surgical site infections and cross-contamination between patients.
- Cost-Effectiveness: Reusable autoclavable cameras are cost-effective in the long run
compared to single-use cameras, as they can be sterilized and reused multiple times.
When: Autoclavable cameras are used throughout the entire laparoscopic cholecystectomy
procedure. They are inserted at the beginning of the surgery and provide continuous visualization
until the completion of the procedure. After use, the cameras are carefully removed, sterilized
through autoclaving, and prepared for the next surgery.
18 | P a g e
Trocars 5 and 10 mm - enabling
minimally invasive access and
accommodating different laparoscopic
instruments, ultimately leading to
reduced patient discomfort and faster
recovery.
Here's a breakdown of what, how,

where, why, and when it is used:
What: Trocars come in various sizes, such as 5mm and 10mm, indicating their diameter. They
consist of a sharp, pointed instrument inside a protective sleeve and are used to create access
points (port sites) in the abdominal wall. These access points allow the insertion of laparoscopic
instruments, including the laparoscope and other surgical tools.
How: Trocars of different sizes (5mm and 10mm) are used as follows:
- Incisions: Small incisions, typically 5mm or 10mm in size, are made in the patient's abdomen
at specific locations.
- Trocars Insertion: Trocars, with their sharp pointed tips protected by sleeves, are inserted
through the incisions and into the abdominal cavity. The sleeves are then removed, leaving
the trocars in place.
- Instrument Insertion: Laparoscopic instruments, including the laparoscope, scissors, graspers,
and electrocautery devices, are inserted through the trocars to perform the surgery. 5mm
trocars are suitable for smaller instruments, while 10mm trocars allow for larger instruments or
those requiring more maneuverability.
Where: Trocars with different diameters (5mm and 10mm) are placed at specific locations on the
patient's abdomen.
Why: Different-sized trocars are used for various reasons during laparoscopic cholecystectomy:
- Minimally Invasive Access: Both 5mm and 10mm trocars allow surgeons to perform surgeries
through small incisions, reducing trauma to the body, minimizing post-operative pain, and
promoting faster recovery.
19 | P a g e
- Instrument Compatibility: 5mm trocars accommodate smaller instruments, while 10mm trocars
allow for the use of larger instruments or instruments that require more space for movement
and manipulation.
- Versatility: Using a combination of 5mm and 10mm trocars provides surgeons with flexibility,
enabling them to choose the appropriate instruments for each step of the procedure.
When: Trocars of different sizes (5mm and 10mm) are used at the beginning of the laparoscopic
cholecystectomy procedure. They are inserted into the abdominal wall after insufflating the
abdominal cavity with carbon dioxide gas, creating a pneumoperitoneum (inflated abdominal cavity)
that allows for better visualization and manipulation during the surgery.
Monopolar L-hook electrode - is a

valuable electrosurgical tool used in
laparoscopic cholecystectomy
procedures for its precision in cutting and
coagulating tissues, promoting
hemostasis, and enabling efficient
dissection
What: It is a handheld device with a long, thin shaft and a hook-shaped, electrified tip. The electrode
is used to cut tissue and coagulate blood vessels by delivering controlled electrical energy.
How: it is used to precisely cut tissues and coagulate blood vessels during a laparoscopic
cholecystectomy procedure. It is connected to an electrosurgical generator, and when activated, it
delivers electrical current to the tissue, causing it to be cut and coagulated simultaneously.
Where: is used inside the abdominal cavity during a laparoscopic cholecystectomy. It is inserted
through one of the trocars (small incisions made in the patient's abdomen) and used to dissect
tissues, cut the gallbladder, and control bleeding if necessary.
Why: The monopolar L-hook electrode is used in laparoscopic cholecystectomy for several reasons:
- Precision Cutting: Its hook-shaped tip allows surgeons to make precise cuts on tissues,
especially when working in confined spaces.
- Hemostasis: By delivering electrical energy, the electrode coagulates blood vessels,
minimizing bleeding and ensuring hemostasis during the surgery.
- Tissue Dissection: Surgeons use the electrode to dissect tissues, including separating the
gallbladder from surrounding structures, ensuring a safe removal process.
- Versatility: The L-hook electrode is versatile and can be used for various dissection and
coagulation tasks, enhancing its utility in different stages of the surgery.
20 | P a g e
When: it is used at specific stages of the laparoscopic cholecystectomy procedure, including cutting
the gallbladder from the liver bed, dissecting tissues, coagulating blood vessels to control bleeding,
and ensuring precision during the surgery. Its usage depends on the surgeon's judgment and the
specific requirements of the procedure.
Right Angle L-Hook- is a valuable

electrosurgical tool used in laparoscopic
cholecystectomy procedures for its precision in
cutting tissues, promoting hemostasis, and
enabling efficient dissection. Its design
allows surgeons to work with accuracy and
control.
What: It features a right-angled, hook-shaped tip at the end of a long, thin shaft. The electrode is
used for precise cutting and coagulation of tissues during surgery.
How: it is used to cut tissues and coagulate blood vessels during a laparoscopic cholecystectomy
procedure. It is connected to an electrosurgical generator and activated to deliver controlled
electrical energy. Surgeons can manipulate the electrode with precision, making it suitable for
intricate dissections and hemostasis.
Where: used inside the abdominal cavity during a laparoscopic cholecystectomy. It is inserted
through one of the trocars (small incisions made in the patient's abdomen) and employed to cut the
gallbladder, dissect tissues, and control bleeding by coagulating blood vessels.
Why: Surgeons use the right-angle L-hook electrode in laparoscopic cholecystectomy for several
reasons:
- Precision Cutting: The right-angled, hook-shaped tip allows for precise cutting of tissues,
ensuring accuracy when dissecting delicate structures around the gallbladder.
- Hemostasis: The electrode coagulates blood vessels, minimizing bleeding and ensuring
hemostasis during the surgery, which is crucial for a safe procedure.
- Tissue Dissection: Surgeons use the electrode to dissect tissues, including separating the
gallbladder from surrounding structures, ensuring a safe and controlled removal process.
When: used at specific stages of the laparoscopic

cholecystectomy procedure, such as cutting the gallbladder from the liver bed, dissecting tissues,
and controlling bleeding. Its usage depends on the surgeon's judgment, the specific requirements of
the surgery, and the patient's anatomy
21 | P a g e
3D Imaging system - 3D imaging systems are utilized in laparoscopic cholecystectomy procedures
to provide enhanced depth perception, enabling surgeons to perform precise dissections and
reducing the risk of errors
What: A 3D imaging system in laparoscopic surgery provides three-dimensional visualization of the

surgical field. 3D imaging system displays depth and spatial relationships, enhancing the surgeon's
perception of the anatomy.
How: use specialized cameras and monitors to create a three-dimensional image. Polarized glasses
or other viewing devices are worn by the surgical team to perceive the depth. The system processes
images from multiple cameras to create a stereoscopic effect, giving the illusion of depth.
Where: The cameras and monitors are set up within the sterile field, allowing the surgeon and the
surgical team to view the 3D images in real time.
Why: 3D imaging systems are used in laparoscopic cholecystectomy for several reasons:
- Enhanced Depth Perception: 3D visualization provides better depth perception, enabling

surgeons to accurately assess the spatial relationships between organs and tissues.
- Precise Dissection: Improved depth perception allows for more precise dissection, especially
around delicate structures like blood vessels and bile ducts.
- Reduced Surgical Errors: Enhanced visualization reduces the risk of errors, improving the
overall safety and success of the surgery.
When: Surgeons may opt for 3D visualization in cases where enhanced depth perception is crucial,
such as when dealing with complex anatomical variations or challenging surgical scenarios.
Allis Tissue Forcep - two Allis clamps are

used in laparoscopic cholecystectomy
procedures to grasp and manipulate tissues,
providing better visualization and assisting in
the dissection process.
Here's a breakdown of what, how, where, why,

and when it is used:
22 | P a g e
What: used to hold and manipulate tissues during procedures. In a laparoscopic cholecystectomy
procedure, two Allis clamps used simultaneously to grasp and manipulate tissues or structures within
the abdominal cavity.
How: They are placed through trocars (small incisions) in the patient's abdomen during laparoscopic
cholecystectomy. Surgeons use these clamps to hold tissues, such as the gallbladder or surrounding
structures, allowing for better visualization and precise dissection.
Where: Allis clamps are used inside the abdominal cavity during laparoscopic cholecystectomy
procedures. They are inserted through trocars, providing access to the surgical area near the
gallbladder.
Why: Two Allis clamps used in:
- Tissue Manipulation: They are used to grasp and manipulate tissues, providing better
exposure of the surgical area and assisting in the dissection process.
- Retraction: Allis clamps can be used to gently pull tissues aside, creating a clear field of view
for the surgeon and ensuring safe dissection around delicate structures.
When: Allis clamps are used at specific stages of a laparoscopic cholecystectomy procedure,
especially during the dissection and removal of the gallbladder. Surgeons use them when precise
manipulation and retraction of tissues are required to safely complete the surgery.
Kelly Curve - also known as Kelly forceps or

hemostats, are versatile surgical instruments
commonly used in various procedures,
including laparoscopic cholecystectomy.

What: These forceps have a curved, clamp-like structure with serrated jaws, allowing surgeons to
grasp, hold, or manipulate tissues and blood vessels during surgery.
How: Kelly curved forceps are inserted through trocars, which are small incisions made in the
patient's abdomen. Surgeons use these forceps to grasp and manipulate tissues, such as the
gallbladder or blood vessels, allowing for precise dissection and removal.
Where: Kelly curved forceps are used inside the abdominal cavity during laparoscopic
cholecystectomy procedures. They are inserted through trocars, providing access to the surgical
area near the gallbladder.
23 | P a g e
Why: Kelly curved forceps are used in:
- Tissue Manipulation: They allow surgeons to grasp and manipulate tissues, providing better
- Hemostasis: Kelly curved forceps can be used to clamp and control blood vessels, minimizing
bleeding during the surgery.
- Tissue Dissection: Surgeons use these forceps to dissect tissues, separating the gallbladder
from surrounding structures with precision.
When: Kelly curved forceps are used especially during the dissection and removal of the gallbladder.
Surgeons use them when precise manipulation and retraction of tissues are required to safely
complete the surgery.
Army Navy Retractor - the Army Navy

retractor aiding surgeons by providing
clear visualization and facilitating precise
dissection and removal of the gallbladder

What: It is a handheld, double-ended retractor with one curved and one flat blade. The curved blade
has a concave shape, while the flat blade is broader.
How: the Army Navy retractor used to retract tissues, providing better visualization and access to the
surgical area. Surgeons or assistants grasp the retractor's handles and gently pull the tissues aside,
creating a clear field of view for the surgeon to perform the surgery.
Where: used inside the abdominal cavity during laparoscopic cholecystectomy procedures. It is
inserted through trocars (small incisions) in the patient's abdomen, allowing access to the gallbladder
and surrounding structures.
Why: The Army Navy retractor is used in laparoscopic cholecystectomy for several reasons:
- Tissue Retraction: It helps retract tissues, such as the liver or intestines, providing the
surgeon with a clear view of the gallbladder and surrounding anatomy.
- Visualization: By gently pulling tissues aside, the retractor enhances visualization, allowing for
precise dissection and removal of the gallbladder.
- Safety: Clear visualization of the surgical area is crucial for ensuring safe dissection and
minimizing the risk of injury to surrounding structures.
24 | P a g e
When: The Army Navy retractor is used at specific stages of a laparoscopic cholecystectomy
procedure when tissue retraction and better visualization are necessary. Surgeons and their
assistants use the retractor as needed throughout the surgery to optimize the surgical field.
Thumb Forcep- also known as surgical tweezers or

pickups, are handheld instruments with two
opposing blades and a spring mechanism.
What: Surgeons or assistants use thumb forceps to grasp, hold, or manipulate tissues, sutures.
How: thumb forceps used through trocars (small incisions) in the patient's abdomen. Surgeons use
these forceps to grasp tissues, such as the gallbladder or blood vessels, allowing for precise
manipulation and dissection. The spring mechanism allows the forceps to remain closed until
pressure is applied with the thumb and forefinger.
Where: Thumb forceps are used inside the abdominal cavity during laparoscopic cholecystectomy
procedures. They are inserted through trocars, providing access to the surgical area near the
gallbladder and surrounding structures.
Why: Thumb forceps are used in laparoscopic cholecystectomy for several reasons:
- Tissue Manipulation: They allow surgeons to grasp and manipulate tissues, providing better
- Hemostasis: Thumb forceps can be used to clamp and control blood vessels, minimizing
bleeding during the surgery.
- Suturing: Surgeons use thumb forceps to hold sutures while performing delicate stitching
procedures, ensuring accurate suturing of tissues.
When: Thumb forceps are used at various stages of a laparoscopic cholecystectomy procedure
when precise tissue manipulation, hemostasis, or suturing is required. Surgeons and their assistants
use thumb forceps as needed throughout the surgery to optimize the surgical field and ensure the
procedure is conducted safely and effectively.
25 | P a g e
Needle Holder
What: A needle holder is a surgical instrument designed to hold a suture needle firmly, allowing the
surgeon to pass the needle through tissues and facilitate suturing during various procedures,
including laparoscopic cholecystectomy.
How: is used to grasp the needle while suturing internal or external tissues. The surgeon or assistant
uses the needle holder to manipulate the needle, pass it through tissues, and tie sutures securely.
Where: They are inserted through trocars, small incisions made in the patient's abdomen, allowing
surgeons to suture internal structures or close incisions.
Why: Needle holders are essential in laparoscopic cholecystectomy for several reasons:
- *Precise Suturing: They provide a firm grip on the needle, allowing for precise control and
accurate placement of sutures, especially in delicate areas.
- Efficient Tissue Closure: Needle holders enable surgeons to close incisions or secure tissues
effectively, promoting proper wound healing after the surgery.
- Minimized Trauma: Precise suturing with needle holders helps minimize tissue trauma,
reducing the risk of complications and promoting faster recovery for the patient.
When: Needle holders are used at specific stages of a laparoscopic cholecystectomy procedure
when suturing internal structures, closing incisions, or securing tissues is required. Surgeons and
their assistants use needle holders as needed throughout the surgery to ensure proper closure and
secure suturing.
Towel Clip - They are used to provide gentle

tissue retraction, secure drapes, and assist in
controlling bleeding when necessary
Here's a breakdown of what, how, where, why,

and when it is used:
26 | P a g e
What: A towel clip, also known as a surgical clamp or towel forceps, is a grasping instrument used in
various surgical procedures, including laparoscopic cholecystectomy. It has serrated jaws and a
locking mechanism, allowing it to securely hold tissues, drapes, or other objects.
How: In a laparoscopic cholecystectomy procedure, towel clips may be used to secure drapes, hold
tissues, or create a clear field of vision by gently retracting certain structures. Surgeons or their
assistants can use towel clips to grasp tissues or other materials as needed during the surgery.
Where: Towel clips are used inside the abdominal cavity during laparoscopic cholecystectomy
procedures. They can be inserted through trocars, small incisions made in the patient's abdomen, to
grasp tissues or provide gentle retraction.
Why: Towel clips are used in laparoscopic cholecystectomy for various reasons:
- Tissue Retraction: They can be used to retract tissues gently, providing a clear view of the
surgical area for the surgeon.
- Securing Drapes: Towel clips are used to secure sterile drapes around the surgical site,
maintaining a clean and sterile environment.
- Temporary Hemostasis: In some cases, towel clips can be used to clamp blood vessels
temporarily to control bleeding during the surgery.
When: Towel clips are used at specific stages of a laparoscopic cholecystectomy procedure when
tissue retraction, draping, or temporary hemostasis is required. Surgeons and their assistants use
towel clips as needed throughout the surgery to optimize the surgical field and ensure the procedure
is conducted safely and effectively.
Suture - These contribute to the success

and safety of the surgery by enabling
accurate closure of incisions, secure
attachment of tissues, and effective
hemostasis
What: also known as suturing devices or laparoscopic suturing instruments, are specialized tools
used in laparoscopic cholecystectomy procedures to close incisions, secure tissues, or ligate blood
vessels using sutures (stitches).
How: designed with long, thin shafts and curved or straight needles at their tips. These instruments
are inserted through trocars (small incisions) in the patient's abdomen. Surgeons manipulate the
27 | P a g e
instruments to pass the needle and suture through tissues, creating secure closures or ligating blood
vessels.
Where: Surgical suture instruments are used inside the abdominal cavity during laparoscopic
cholecystectomy procedures. Surgeons insert these instruments through trocars, providing access to
the gallbladder and surrounding structures.
Why: Surgical suture instruments are used in laparoscopic cholecystectomy for various reasons:
- Closing Incisions: After removing the gallbladder or completing other necessary procedures,
sutures are used to close the small incisions made for trocars.
- Securing Tissues: Suturing instruments are used to secure tissues, especially when delicate
structures need to be reattached, repositioned, or when internal structures need
reinforcement.
- Hemostasis: Suturing instruments are used to ligate blood vessels, controlling bleeding and
ensuring hemostasis during the procedure.
When: used at different stages of a laparoscopic cholecystectomy procedure, including closing

incisions, securing tissues, and controlling bleeding. The timing of their use depends on the specific
requirements of the surgery and the surgeon's judgment.
Scalpel - scalpels are used in laparoscopic

cholecystectomy procedures to make small, precise
incisions (trocars) on the patient's abdomen
What: A scalpel is a small, sharp knife with a thin, straight or curved blade, commonly used in
various surgical procedures, including laparoscopic cholecystectomy. It is used for making incisions
in tissues and organs.
How: a scalpel may be used for making small incisions called trocars. These trocars serve as entry
points for specialized laparoscopic instruments and the laparoscope, allowing surgeons to access
the abdominal cavity.
Where: Scalpels are used on the patient's skin at specific anatomical locations where trocars need
to be inserted. These incisions are usually made in the upper abdomen during laparoscopic
cholecystectomy.
Why: Scalpels are used in laparoscopic cholecystectomy for the following reasons:
28 | P a g e
- Precision: Scalpels allow surgeons to make precise incisions with controlled depth, ensuring
minimal tissue trauma.
- Access: The incisions made with scalpels provide access points for trocars, enabling the
insertion of laparoscopic instruments and the laparoscope into the abdominal cavity.
- Minimized Trauma: Scalpel incisions are typically smaller and result in less tissue damage
compared to larger incisions made during traditional open surgeries.
When: Scalpels are used at the beginning of a laparoscopic cholecystectomy procedure when the
surgeon is preparing to insert trocars. The incisions made with scalpels are crucial for providing
access to the surgical area, allowing the surgeon to perform the procedure using laparoscopic
techniques.
Zen abdominal Retractor - Zen retractor is specifically

designed to facilitate access and exposure of the
gallbladder and surrounding structures during
laparoscopic surgery.
Here's a breakdown of what, how, where, why, and

when it is used:
What: The Zen abdominal retractor is a specialized surgical instrument designed to retract and hold
tissues during laparoscopic cholecystectomy.
How: The surgeon uses the Zen retractor by inserting its blades or arms into the abdominal cavity
through one of the small incisions made for trocars. Once inside, the Zen retractor is carefully
positioned to lift and hold the gallbladder and/or other tissues, providing better exposure and access
to the surgical site.
Where: The Zen retractor is used within the abdominal cavity during a lap chole procedure. It is
positioned in a way that optimizes the view of the gallbladder and surrounding structures.
Why: Surgeons use the Zen abdominal retractor in lap cholecystectomy for several reasons:
- To provide enhanced exposure and visualization of the gallbladder, liver, and surrounding
structures.
- To create a spacious and well-defined working area, which improves surgical precision and
safety.
- To reduce the risk of inadvertent injury to nearby structures, such as the common bile duct or
blood vessels, by keeping them out of the way.
29 | P a g e
When: The Zen retractor is typically used after the initial insertion of trocars and the laparoscope.
Once the surgeon has identified the gallbladder and surrounding anatomy, the Zen retractor can be
employed to optimize exposure and access throughout the procedure, especially during dissection
and removal of the gallbladder.
Sponges - They are used to absorb fluids, maintain a clear surgical field, and prevent
contamination, contributing to the success and safety of the surgery.
What: Sponges, also known as laparotomy sponges or surgical sponges, are sterile pieces of fabric
used in surgical procedures, including laparoscopic cholecystectomy. They come in various sizes
and are highly absorbent.
How: Sponges are used in laparoscopic cholecystectomy to absorb blood and other fluids, keeping
the surgical area dry and clear. They can be applied to the incision sites or used internally to absorb
fluids during the procedure.
Where: Sponges are used inside the abdominal cavity during laparoscopic cholecystectomy
procedures. They are inserted through trocars (small incisions) and can be placed strategically to
absorb fluids around the gallbladder and other organs.
Why: Sponges are used in laparoscopic cholecystectomy for several reasons:
- Absorption: They absorb blood and other fluids, maintaining a clear surgical field and
improving visibility for the surgeon.
- Preventing Contamination: By absorbing fluids, sponges help prevent contamination of
surrounding tissues and organs.
- Minimizing Complications: A clear surgical field reduces the risk of complications, ensuring the
surgeon can perform the procedure accurately and safely.
When: Sponges are used throughout the laparoscopic cholecystectomy procedure as needed.
Surgeons and their assistants use sponges to absorb fluids, maintain a clear view, and prevent
contamination. Sponges are used at various stages of the surgery, depending on the specific
requirements of the procedure and the patient's condition.
Mayo Curve - Surgeons use the Mayo curve in

laparoscopic cholecystectomy (lap chole)
procedures to facilitate the dissection and
removal of the gallbladder.
30 | P a g e
What The Mayo curve is a handheld surgical instrument that resembles a long, slender, and curved
rod. It's typically made of stainless steel and is designed for minimally invasive procedures like
laparoscopic cholecystectomy.
How: The Mayo curve is a specific type of laparoscopic instrument that has a curved and blunt tip.
Surgeons use it to gently push aside and retract tissues and organs in the abdominal cavity, creating
space to access and remove the gallbladder.
Where: Surgeons use the Mayo curve inside the patient's abdominal cavity, specifically to
manipulate and move surrounding tissues and organs, allowing for better visibility and access to the
gallbladder.
Why: The Mayo curve helps surgeons work safely and efficiently during lap cholecystectomy by
providing atraumatic retraction of tissues. This minimizes the risk of injury to adjacent structures and
facilitates the dissection and removal of the gallbladder.
When: The Mayo curve is used throughout the laparoscopic cholecystectomy procedure, from
creating the initial access port to exposing the gallbladder and its attachments. Surgeons use it as
needed to optimize the surgical field and ensure a successful and safe operation.
31 | P a g e
COURSE IN THE P.A.C.U / RECOVERY ROOM
Date & Doctor’s Order Rationale Nursing Responsibilities
Time
September  To PACU For continuously  Continuously monitor
26, 2023
monitoring and patient’s vital signs,
management of patient airway and level of
consciousness
 Implement fall prevention
and safety measures
 Provide oxygen support
as needed
 Low Fat Diet This diet focuses on  Inform the dietitian about
once fully awake foods that require the diet of the patient.
with strict minimal chewing and
aspiration are less to stuck in
precaution patient’s throat or
esophagus, reducing
the risk of aspiration.
 Moderate to high  Improves lung  Ensure that the patient is
back rest expansion and comfortable with the back
ventilation rest position
 Help reduce  Adjust the backrest to
32 | P a g e
strain on the appropriate angle
surgical incision  Provide safety
site
 O2 support via It ensures that patient  Administer oxygen
face mask of 6-8 receive a sufficient therapy according to the
LPM supply of oxygen. order.
 Adjust the oxygen flow
rate to maintain the
patient’s SPO2 within the
target range
 Monitor the patient’s
respiratory status
 Present IVF rate: Tramadol is for pain
30-32 gtts + management
Tramadol 50 mg
amp
 IVF to 1L D5LRS helps maintain  Check the patency of the
 (1) D5LRS 1L x 8 electrolyte balance. IV line
hours + Tramadol  Regulate the IVF
50mg amp
 (2) D5LRS 1L x 8
hours
 (3) D5LRS 1L x 8
hours
MEDICATIONS:
 Ketorolac 30 mg For pain management  Monitor blood pressure
slow IV q6 x 6  Asses for patient’s pain
doses (ANST) levels
 Monitor the side effects
like dizziness and
drowsiness
 Notify the AP regarding to
the side effects that the
patient is experiencing.
 Paracetamol 1g For pain management  Monitor blood pressure
IV infusion for 15
mins q8 for 2  Asses for patient’s pain
more doses levels

33 | P a g e
like dizziness and
drowsiness

patient is experiencing
 Nubain 5 mg SIV For pain management  Monitor blood pressure

PRN q4-q6 for  Asses for patient’s pain
severe pain levels
like dizziness and
drowsiness
 Shift IV antibiotic To prevent surgical site  Monitor the patient’s vital
to cefuroxime 5 infection signs, especially
mg 2 x a day for temperature, for signs of
1 week infection
 Observe for any signs of
an allergic reaction, such
as rush, itching, swelling
or difficulty of breathing
 Omeprazole 40  To inhibit the  Monitor the patient for
mg IV once a day production of any signs of an GI
for one more acid in the discomfort or bleeding
dose stomach  Pay attention to
 To reduce the electrolyte imbalances if
risk of NSAID- omeprazole is used long-
induced gastric term, which can affect
irritation potassium and
magnesium levels.
 Metoclopramide To help manage nausea  Monitor the patient for
10 mg IV PRN q8 and vomiting signs of nausea, vomiting
for severe or other GI symptoms, as
nausea & well as the effectiveness
vomiting of Metoclopramide
 Consume IV For pain management  Monitor blood pressure
34 | P a g e
analgesics may
start celecoxib  Asses for patient’s pain
200 mg BID for 1 levels
week  Monitor the side effects
like dizziness and
drowsiness
 Motilium 10 mg To help manage nausea  Monitor the patient for
TID for 3 days and vomiting signs of nausea,
vomiting, bloating or
discomfort
 Be attentive to potential
side effects including dry
mouth or abdominal
cramps
 VS q 15 mins To monitor possible  Record vital signs and
monitoring while deterioration after the update the Attending
at PACU then q1 procedure. Physician regarding to
until stable the abnormalities.
 WOF: untoward For immediate  Monitor vital signs,
s/sx like intervention and especially blood pressure
hypotension, potentially life-saving and temperature
cyanosis, treatment  Notify AP for any signs of
respiratory abnormalities
depression
 Refer For further  Notify the said Attending
management of the Physician for the referral
patient. and for the continuous
management of the
patient.
35 | P a g e
NURSING CARE PLAN
NAME: PATIENT AF
DATE OF ASSESMENT: September 26, 2023
TIME: 9:36 pm
INTRAOPERATIVE
ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Risk for injury SHORT TERM: INDEPENDENT: Throughout the surgical
Objective: and falls related Within the nursing shift 1. Educated the patient 1. Safety awareness, risk procedure, patient was
free from injury and falls
 Patient is to the effect of and throughout the about potential mitigation, postoperative
GOAL MET
under anesthesia surgical procedure effects of anesthesia care
anesthesia secondary to patient will be free from and postoperative
(GAET) laparascopic any falls and injury by grogginess
cholecystectomy implementing safety 2. Closely monitored 2. Closely monitoring
protocols and patient response to ensures patients safety by
procedures. anesthesia and detecting adverse reaction
coordinated with or complications early
anesthesia team
3. Monitored vital signs 3. Some anesthesia drugs
during procedure can affect cardiovascular
system, potentially
causing changes in blood
pressure and heart rate.
4. Prevent falls during
36 | P a g e
4. Assured that the surgery or injuries that
patient is correctly occur if the patient were to
positioned and shift or slide of the table
properly secured to and right positioning
the operation table allows surgeon to work
with clear visibility and
precision.
5. Adequate number of
5. Use a sufficient individuals during transfer
number of people aligns with best practice
throughout the guidelines for patient
transfer, stabilize and handling which are
lock the bed in designed to minimize risk
position, and support and ensure quality care
the client's body and
limbs.
37 | P a g e
NAME: PATIENT AF
TIME: 9:36 pm
INTRAOPERATIVE

DIAGNOSIS
OBJECTIVE: Risk for SHORT TERM: INDEPENDENT:  Throughout the
 Insufficient Hypothermia  Throughout the 1. Monitor heart rate, 1. Cold stress reduces surgical procedure
Clothing related to exposure surgical procedure rhythm, blood pace maker patient’s core body
 Cold to a cold operating patient’s core body pressure and function.HR and BP temperature
operating room environment temperature will be temperature drop as hypothermia maintained at or
room and decreased maintained at or progress and for above 36°C (96.8°F)
 Patient is thermoregulatory above 36°C baseline data for the entire surgery
under mechanisms during (96.8°F) for the 2. Continuously 2. Anesthesia can
anesthesia surgery entire surgery monitored patients affect body’s  Throughout surgical
(GAET) body core thermoregulation procedure patient
 Throughout temperature mechanism, did not experience
surgical procedure continuous any complications
patient will not monitoring allows related to
experience any anesthesia team to hypothermia
complications intervene promptly
related to 3. Ensured that the 3. These methods GOAL MET
hypothermia patient is uncovered provide for a more
only to the extent gradual warming of
38 | P a g e
necessary for the the body and prevent
surgical procedure. heat loss
Covered exposed
body parts when not
in use
4. Regulated the 4. Help prevent
environment potential risk for
temperature by hypothermia and
maintaining shivering common
appropriate room response to
temperature hypothermia and it
may complicate
surgery by causing
movement
5. Give extra covering 5. Warm blankets
such as clothing and provide a passive
blankets; cover method of warming
postoperative and prevent
patients with heat hypothermia during
retaining blankets or surgery and
provided thermal recovery.
heating device like
drop light to the
patient
39 | P a g e
NAME: PATIENT AF
TIME: 9:36 pm
INTRAOPERATIVE

DIAGNOSIS
OBJECTIVE: Risk for hypotension SHORT TERM: INDEPENDENT:
 Patient is related to internal  Throughout the 1. Continuously 1. Anesthesia can  Throughout the
surgical procedure
in bleeding and surgical procedure monitored blood induced hypotension,
patient’s blood
anesthesia administration of patient’s blood pressure monitoring enables pressure are close
anesthesia pressure are within early detection and within normal range,
range of 110/80
VITAL SIGNS secondary to normal range or allow prompt
mm/Hg
BP: 130/80 laparoscopic close within intervention to
mm/Hg cholecystectomy normal range prevent inadequate  Throughout surgical
tissue perfusion and procedure patient
(120/80 mm/Hg)
did not experience
organ damage. any complications
 Throughout 2. Ensured proper 2. Incorrect positioning related to
surgical procedure patient positioning can compress major hypotension (low
blood pressure)
patient will not blood vessel that can
experience any impede blood flow
GOAL MET
complications leading to low
related to cardiac output and
hypotension (low consequently
blood pressure)
40 | P a g e
hypotension
3. Promptly notified
anesthesia team of 3. Early management
any concerning and intervention
changes in blood
pressure
DEPENDENT:
4. Administered
intravenous fluids 4. Presence of dextrose
D5LR helps maintain
osmotic pressure in
blood vessels which
can help prevent
5. Adjust IVF rate based hypotension
on patients need to 5. In cases Fluid
prevent fluid overload overload, the heart
may struggle to
pump the increased
volume of blood,
leading to reduced
6. Be prepared to cardiac output
administer 6. Certain anesthetic
vasopressor agents can lead to
41 | P a g e
medications as vasodilation,
prescribed like norepinephrine
norepinephrine counters vasodilation
by causing
constriction.
NAME: PATIENT AF
TIME: 10:45 pm
POSTOPERATIVE

DIAGNOSIS
42 | P a g e
Objectives: Risk for impaired SHORT TERM: INDEPENDENT: After 30 minutes of
 Patient is breathing pattern Within 1 hour of nursing 1. Closely monitored 1. Anesthesia can nursing
in post- related to post intervention patient will and assessed cause relaxation of demonstrated
anesthesia anesthesia be able to demonstrate patient’s respiratory airway muscle, improved
secondary to improved respiratory status potentially leading to respiratory function
Laparascopic function by maintaining airway obstruction or by maintaining 12-
Vital signs: cholecystectomy 12-20 breaths per minute risk of aspiration 20 breaths per
BP:130/90 and oxygen saturation 2. Ensured patients 2. Prevent respiratory minute and oxygen
mm/hg level of 97% or higher airway is clear and compromise and saturation level of
RR: 15 while breathing room air unobstructed maintain adequate 99% while
O2 breathing breathing room air
saturation:95%
3. Prepared suctioning 3. Suctioning help GOAL MET
materials in case of prevent aspiration
secretion
4. Positioned the patient
with the head of bed
elevated if tolerated 4. Helps maintain a
patent airway and
DEPENDENT minimize risk of
5. Administered airway obstruction
supplemental oxygen
with flow rate of 6-8 5. Patients in post
lpm anesthesia may have
43 | P a g e
reduced respiratory
function,
supplemental oxygen
6. Administered can assist
Ketorolac 30mg,
6. Pain management,
Paracetamol 1g,
adequately pain
Tramadol 50 mg
management to
1amp, Celecoxib
encourage to
200mg, Nubaine 5
breathe deeply and
mg
prevent shallow
breathing
DRUG STUDY
DRUG NAME MECHANISM OF ACTION INDICATION & SIDE EFFECT AND NURSING RESPONSIBILITIES
CONTRAINDICATION ADVERSE REACTION
Generic Name: Thought to produce Indication:  Headache Before:
Paracetamol analgesics by inhibiting for pain management  Drowsiness  Assess any history of allergy.
prostaglandin and other  Rash
substances that sensitive  Nausea and Vomiting
44 | P a g e
Brand Names: pain receptors. Constipation During:
 abdominal pain  Follow the rights of medication
Classification: Contraindication: administration.
 Instruct patient to report discomfort at
Analgesics Contraindicated in patients IV site.
hypersensitive to drug.
Dosage: After:
1g  Instruct patient to report immediately
all hypersensitivity reaction.
Route:  Monitor the patient’s response to the
Intravenous medication.
Frequency:
Q8
Generic Name: Inhibits proton pump Indication:  Nausea and vomiting Before:
Omeprazole To inhibit the production of
activity by binding to  Headache  Assess for possible contraindications
acid in the stomach.
Brand Names: hydrogen-potassium  Diarrhea and cautions: history of allergy to a
Prilosec
adenosine triphosphatase,  Constipation proton pump inhibitor to reduce the
45 | P a g e
Classification: located at secretory Contraindication:  Back pain risk of hypersensitivity reaction
Antiulcer drugs Contraindicated in patients
surface of gastric parietal  Rash
hypersensitive to drug or its
Dosage: cells, to suppress gastric  Abdominal pain
40 mg components and in patients
acid secretion. During:
receiving rilpivirine-
Route:  Follow the rights of medication
Intravenous containing products.
administration.
Frequency:  Instruct patient to report discomfort at
OD
IV site.
 Monitor the patient for any signs of
an GI discomfort or bleeding.
After:
 Tell patient to report all
hypersensitivity reaction.
 Monitor the patient’s response to the
medication.
Generic Name: Stimulants mobility of Indication:  Restlessness Before:
Metoclopramide To prevent or reduce  Assess any history of allergy with this
upper GI tract, increases  Drowsiness
postoperative nausea and drug.
46 | P a g e
Brand Name: lower esophageal vomiting  Fatigue  Keep diphenhydramine injection
Regan readily available in case
sphincter tone, and blocks  Insomnia
extrapyramidal reactions occur.
Classification: dopamine receptors at the  Dizziness
GI stimulants Contraindication: During:
chemoreceptor trigger  Anxiety
Contraindicated in patients  Follow the rights of medication
Dosage: zone.  Transient administration.
hypersensitive to drug.
10 mg  Instruct patient to report discomfort at
hypertension
IV site.
Route:  Nausea  Monitor the patients BP carefully.
Intravenous
 Diarrhea
After:
Frequency:  Tell patient to report immediately all
Q8, PRN hypersensitivity reaction.
medication.
Generic Name: Inhibits cyclooxygenase-2, Indication:  Headache Before:
Celecoxib the enzyme responsible for pain management  Rash  Assess any history of allergy.
for prostaglandin synthesis  Nausea and Vomiting
47 | P a g e
Brand Names: Constipation  Assess for patient’s pain level.
CeleBREX  abdominal pain
 Dizziness During:
Classification: Contraindication:  Fatigue  Follow the rights of medication
NSAID’s Contraindicated in patients administration.
hypersensitive to drug.  Instruct patient to swallow tablets
Dosage: whole; do not crush them.
200mg
After:
Route:  Instruct patient to report immediately
Oral all hypersensitivity reaction.
Frequency: medication.
BID
Generic Name: May inhibits prostaglandin Indication:  Diarrhea Before:
Ketorolac
synthesis to produce anti- It is used for pain  Assess any history of allergy with this
48 | P a g e
inflammatory, analgesic, management  Vomiting drug.
Brand Names:
and antipyretic effects.  Nausea  Monitor the patient’s blood pressure
Acular
 Headache before and after administering drug.
Classification:
Contraindication:  Dizziness During:
Nonsteroidal anti-
inflammatory (NSAID) Contraindicated in patients  Fatigue  Follow the rights of medication
hypersensitive to drug.  Rash administration
Dosage:
30 mg  Constipation  Instruct patient to report discomfort at
 GI pain IV site.
Route:
Intravenous After:
Frequency:
Q6 hypersensitivity reaction.
medication.
Generic Name: Inhibits cell-wall synthesis Indication:  Rash Before:
Cefuroxime To treat infections
promoting osmotic  Assess any history of allergy with this
49 | P a g e
instability usually  Diarrhea drug.
Brand Names:
bactericidal.  Nausea  Inform patient need and importance
Zinacef
Contraindication:  Vomiting of the drug to him/her.
Classification: Contraindicated in patients  Anorexia
Antibiotics
hypersensitive to drug or  Stomach pain During:
Dosage: other cephalosporins.  Dizziness  Follow the rights of medication
5 mg
 Drowsiness administration.
Route:
 Instruct patient to report discomfort at
Intravenous
IV site.
Frequency:
BID
After:
hypersensitivity reaction.
medication
Generic Name: Binds with opioid Indication:  Drowsiness Before:
Nalbuphine receptors in the cns, For pain management  Dizziness  Assess any history of allergy.
altering perception of the  Dry mouth  Assess for patient’s pain levels
50 | P a g e
Brand Names: emotional response to  Constipation
Nubain pain. Contraindication: During:
Contraindicated in patients  Follow the rights of medication
Classification: hypersensitive to drug. administration.
Opioid analgesics  Instruct patient to report discomfort at
IV site.
Dosage:
After:
5mg
 Reassess patient’s level of pain at
least 15 to 30 minutes after
Route:
administration.
Intravenous
 Instruct patient to report immediately
Frequency:
PRN, Q4-Q6
medication.
Generic Name: Acts by blocking dopamine Indication:  Headache Before:
51 | P a g e
receptors in the  Dizziness
Domperidone gastrointestinal tract, Management of nausea and  Gastrointestinal  Assess any history of allergy.
which leads to increased vomiting disturbance  Monitor the baseline vital signs.
Brand Names: mobility of the stomach During:
Motilium and small intestine.  Follow the rights of medication
administration.
Classification: Contraindication:  Administer the medication, with or
Dopamine receptor Contraindicated in patients without food, depending on the
antagonist and a hypersensitive to drug. condition being treated.
prokinetic agent  Instruct patient to swallow tablets
whole; do not crush them.
Dosage:
After:
10 mg
 Instruct patient to report immediately
Route:
Oral
medication.
Frequency:
TID
DRUG NAME MECHANISM OF INDICATION & SIDE EFFECT AND ADVERSE NURSING RESPONSIBILITIES
ACTION CONTRAINDICATION REACTION
Generic Name: Unknown. Thought to bind Indication:  Constipation Before:
Tramadol to opioid receptors and For pain management  Dizziness  Instruct patient to immediately
inhibits reuptake of  Drowsiness report hypersensitivity reaction.
52 | P a g e
Brand Name: norepinephrine and  Loss of appetite
Conzip serotonin.  Nausea and vomiting During:
Contraindication:  Sweating  Assess patient’s level of pain at
Classification: Contraindicated in patients  Muscle weakness least 30 minutes after
Analgesics hypersensitive to drug or administration.
opioids.
Actual Dosage: After:
50 mg  Discontinue drug and notify
physician if sign and symptoms
Route: of hypersensitivity occur.
Intravenous
Frequency:
Q8
ANESTHESIA MEDICATIONS
Generic Name: Enhances action of Indication:  Drowsiness Before:
gamma-aminobutyric acid
53 | P a g e
Midazolam (GABA) one of the major Preoperative sedation  Dizziness  Assess any history of allergy.
inhibitory neuro-  Confusion  Educate the patient about the
Brand Names: transmitters in the brain.  Hypotension medication, its purpose, and potential
Buccolam side effects.
Contraindication:  Monitor vital signs before and after
Classification: Contraindicated in patients the medication administration.
Benzodiazepine hypersensitive to drug.
During:
Dosage:  Follow the rights of medication
2 mg administration.
 Continuously monitor the patient’s
Route: vital signs, oxygen saturation, and
Intravenous level of sedation.
Frequency: After:
medication.
Generic Name: A short-acting general Indication:  Hypotension Before:
Propofol anesthesia that enhances Used for induction of  Respiratory  Assess any history of allergy.
the inhibitory effects of Anesthesia depression  Monitor vital signs before and after
54 | P a g e
Brand Names: GABA in the central  Pain in the injection the medication administration.
Diprivan nervous system. site
 Bradycardia During:
Classification: Contraindication:  Continuously monitor the patient’s
General anesthetics Contraindicated in patients vital signs, oxygen saturation, and
hypersensitive to drug. level of sedation
Dosage:  Be prepared to manage any potential
100 mg complications, such as hypotension
or respiratory depression
Route:
Intravenous
After:
medication
Generic Name: Works by blocking the Indication:  Tachycardia Before:
Rocorunium action of acetylcholine at For inpatients and  Bradycardia  Assess any history of allergy.
55 | P a g e
neuromuscular junction, outpatients as an adjunct to  Monitor vital signs before and after
Brand Names: leading to temporary general anesthesia. the medication administration.
Zemuron skeletal muscle paralysis.
During:
Classification:  Follow the rights of medication
Non-depolarizing Contraindication: administration.
neuromuscular Contraindicated in patients  Continuously monitor the patient’s
blocking agent hypersensitive to drug. vital signs, oxygen saturation, and
level of sedation
Dosage:
After:
30 mg
medication.
Route:
Intravenous
Frequency:
Q6
Generic Name: A synthetic Opioid that Indication:  Constipation Before:
56 | P a g e
Fentanyl acts on the central Used for induction of  Nausea and vomiting  Assess any history of allergy.
nervous system by binding Anesthesia  Dizziness  Monitor vital signs before and after
Brand Names: to Opioid receptors,  Sedation the medication administration.
Duragesic primarily the mu-Opioid  Respiratory
receptors depression During:
Classification: Contraindication:  Hypotension  Continuously monitor the patient’s
Potent Opioid Contraindicated in patients  Rash vital signs, oxygen saturation, and
analgesics hypersensitive to drug. level of sedation
 Be prepared to manage any potential
Dosage: complications, such as hypotension
50 mg or respiratory depression
After:
Route:
Intravenous
medication.
Generic Name: Sevoflurane induces Indication:  Drowsiness Before:
Sevoflurane anesthesia by binding to For induction and  Dizziness  Assess any history of allergy.
ligand-gated ion channels maintenance of anesthesia  Confusion  Monitor vital signs before and after
57 | P a g e
and blocking CNS  Hypotension the medication administration.
Brand Names: neurotransmission  Nausea
Sevorane  Vomiting During:
Contraindication:  Lightheadedness  Follow the rights of medication
Classification: Contraindicated in patients administration.
Anesthetic agent hypersensitive to drug.  Continuously monitor the patient’s
vital signs, oxygen saturation, and
Dosage: level of sedation.
50 mg
After:
Route:  Monitor the patient’s response to the
Intravenous medication.
Frequency:
Generic Name: Blocks the action of Indication:  Dry mouth Before:
Atropine acetylcholine at To reduce respiratory tract  Blurred vision  Assess any history of allergy.
58 | P a g e
muscarinic receptors, secretions related to  Tachycardia  Monitor vital signs before and after
Brand Names: thereby inhibiting the anesthesia.  Constipation the medication administration.
AtroPen parasympathetic nervous  Nausea
system. Contraindication:  Vomiting
Classification: Contraindicated in patients  Headache During:
Antimuscarinics hypersensitive to drug.  Dry mouth  Continuously monitor the patient’s
vital signs, oxygen saturation, and
Dosage: level of sedation
 Be prepared to manage any potential
Route: complications.
Intravenous
After:
medication.
59 | P a g e

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GENERAL OBJECTIVES

Operating room Preparation:

Infection Control and Aseptic Technique:

Assisting the Surgical Team:

Communication and Teamwork:

 Monitor the patient's vital signs continuously after anesthesia

The primary causes include:

SIGNS AND SYMPTOMS

Laparoscopic cholecystectomy is a minimally invasive surgical procedure used to remove the

PATIENT’S MEDICAL HISTORY

PAST MEDICAL HISTORY

PRESENT MEDICAL HISTORY

- The patient underwent a laparoscopic cholecystectomy on October 26, 2023, at Quirino

FATHER SIDE MOTHER SIDE

GRANDFATHER GRANDMOTHER GRANDFATHER GRANDMOTHER

HTN HTN HTN

The gallbladder is a hollow organ that sits

The gallbladder is divided into three sections:

Physiology of the Gallbladder

Physiology of the Gallbladder with Stones

 Bile Production: The liver continuously

Steps involved in a Laparoscopic Cholecystectomy Procedure

The operating room (OR) offers a place for surgeons to

It is necessary that all surgical / procedural team members

The patient is positioned on the operating table, in a supine

Patient Positioning (lying on the back) position. Ensure proper positioning to

The patient is placed under general anesthesia to ensure they

Creation of Carbon dioxide gas is introduced into the umbilical cavity

Several small incisions are made in the abdominal wall.10mm

A laparoscope, which is a long, thin tube with a light and camera

Dissection and Additional instruments, such as graspers and scissors, are

Once the cystic structures are secured, the surgeon carefully

After confirming there is no bleeding or bile leakage, the trocars

Maryland dissector - is a versatile

Here's a breakdown of what, how, where,

Here's a breakdown of what, how, where, why, and when it is used:

What: An atraumatic grasper is a laparoscopic instrument with a gentle, non-serrated jaw. It is

Here's a breakdown of what, how, where,

How: Laparoscopic Metz scissors are utilized in a laparoscopic cholecystectomy procedure by

Autoclavable Camera - enable surgeons

Here's a breakdown of what, how, where,

What: An autoclavable camera, also known as a sterilizable or autoclavable endoscope, is a

Here's a breakdown of what, how,

Monopolar L-hook electrode - is a

Here's a breakdown of what, how, where, why, and when it is used:

Right Angle L-Hook- is a valuable

Here's a breakdown of what, how, where, why, and when it is used:

When: used at specific stages of the laparoscopic

Here's a breakdown of what, how, where, why, and when it is used:

What: A 3D imaging system in laparoscopic surgery provides three-dimensional visualization of the

- Enhanced Depth Perception: 3D visualization provides better depth perception, enabling

Allis Tissue Forcep - two Allis clamps are

Here's a breakdown of what, how, where, why,

Why: Two Allis clamps used in:

Kelly Curve - also known as Kelly forceps or

Here's a breakdown of what, how, where,

Army Navy Retractor - the Army Navy

Here's a breakdown of what, how, where,

Thumb Forcep- also known as surgical tweezers or

Here's a breakdown of what, how, where, why, and when it is used:

Here's a breakdown of what, how, where, why, and when it is used:

Towel Clip - They are used to provide gentle