Details of Procedure
DVT prophylaxis has been ordered within 24hrs of surgery
Second generation cephalosporin / therapeutic antibiotics were started prior to incision.
The patient was correctly identified, transferred to the operative room. General anesthesia was administered. After his abdomen was prepped and draped in a sterile fashion, a mid-line supraumbilical incision was made and an open Hassan procedure used to place a 12mm trochar. The abdomen was insuflated to 15mmHg. I then placed a 5mm epigastric port followed by a two 5mm right upper quadrant ports.
The gallbladder was visualized in the right upper quadrant. The gallbladder fundus was grasped and retracted over the liver. The infundibulum was grasped and retracted laterally. I then used blunt dissection to dissect out the cystic duct and cystic artery circumfirentially. The critical view was obtainted.
The cystic duct was clipped proximally and a hemiductotomy was created. I then performed cholangiogram with 4Fr catheter on an Olson clamp. Cholangiogram revealed no filling defects with free flow of contrast into duodenum. There were no intra- or extra-hepatic ductal filling defects noted. Cholangiogram was terminated.
The cystic duct was clipped with 2 clips distally and transected. The cystic artery was clipped with 2 clips proximal and 1 clip distal and transected. The gallbladder was removed from the gallbladder bed with electrocaudery. Hemostatsis was obtained in liver bed. The abdomen was irrigated with copious saline. The gallbladder was removed in an endocatch bag through the umbilicus. The abdomen was desuflated and umbilical fascia closed with 0-vicryl. All skin incisions were irrigated and closed with 4-0 monocryl. Local anesthesia and Dermabond were applied to all incisions.
Lap Chole Preferences:
Equipment:
balloon hassan trochar
three 5mm trochars (do not need to be balloon)
11 blade
30 degree scope
suction irrigator
laparoscopic graspers
laparoscopic maryland
laparoscopic kitners
hook cautery
Cholangiogram:
Olsen clamp
4F ureteral catheter
stopcock
full strength contrast
0 vicryl on UR-6
4-0 monocryl
2% Lidocaine with epinephrine
endocatch bag
Patient:
foley unless just urinated (ask MD)
right arm tucked
have bed positioned and ready for flouroscopy