LAPAROSCOPIC

CHOLECYSTECTOMY

Bhrahmantya Sedijono
•
INDICATION
Cholecystectomy is
indicated in symptomatic
patients with proven
disease of gallbladder

• Indication of laparoscopic
cholecystectomy are
essentially those for open
cholecystectomy
 INDICATION AND
CONTRAINDICATION
 PREOPERATIVE
PREPARATION
• History and physical examination
• Diagnosis of biliary disease is documented with
ultrasound of the abdomen
• Evaluation of cardiopulmonary system
• Routine laboratory blood test
• Informed consent about risk and complication
associated with this procedure
• Informed consent about conversion to open procedure
 Method

• Verres Needle
• Blindly
• Incidence of bowel injury 0,06-0,5%
• Incidence of vascular injury 0,05-0,3%
• Mortality cased by large vascular injury 17%
• Hasson Technique
• Mini laparotomy +/- 1cm
• Possible of vascular and visceral injury, but considerred to
safe technique(Hanney 1999)
 Instrument
• Veress Needle
• Trocar
• Scissor
• Grasper
• Coagulation Instrument
• Suction irrigation tube
• Clips applier
• Needle Holder
• Stappler
 ANESTHESIA AND
POSITION
• General anesthesia with endotracheal intubation is
recommended
• Preoperative prophylactic for anticipated bile pathogen
• Supine position with the arm either secure at the side
• The surgeon must have a clear line of sight to both the
video monitor and the high flow of CO2 insufflator
• An orogastric tube is passed after the patient is asleep
• Proper placement of electrocautery grounding pad
OPERATIVE PREPARATION,
INCISION AND EXPOSURE
• The skin of entire abdomen and lower anterior chest is prepared in the
routine manner
• The initial port (umbilical region) 1 cm incision vertically or
horizontally.
• Method of insertion either, open hasson technique or verres neddle
technique
• Second port : midline about 5 cm below the xyphoid
• Third port : right midclavicular line several cm below the costal margin,
or right anterior axillary line almost the level of umbilicus
• Maybe need forth port
• The other port are insert under direct visualization
Open Hasson Technique
Verres Neddle Technique
 ANTEGRADE
CHOLECYSTECTOMY
• the apex of gallbladder fundus is grasped with forcep through lateral
port, and then lift superiorly, for good exposure cystic duct and
artery sometimes need forth port
• Dissecting forcep are used by surgeon through epigastric port to
open the peritoneum over the presumed junction of the gallbladder
and cystic duct
• With gentle teasing and spreading untill important structure are
exposed
• Clipping the cystic duct and artery separetely
• Mobilized the gall bladder from liver bed, and extraction with
specimen retrieval bag
 ANTEGRADE
CHOLECYSTECTOMY
 ANTEGRADE
CHOLECYSTECTOMY
COMPLICATION
 CLOSURE AND POST
OPERATIVE CARE
• Port 1 cm, suturing the fascial layer with absorbable suture,
continued with suturing skin layer with non absorbable suture
• Port 0,5cm, only suturing skin layer with non absorbable
suture
• The orogastric tube remove in operating room after the
procedure
• Pain in incision site is ussually controlled by oral analgesia
• Although patient have some transient nausea, most are able to
take oral liquid within 6-8 hours and maybe discharge home
within one day
 THANK’S

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