The patient was correctly identified, transferred to the operative room. General anesthesia was administered. They were on therapeutic antibiotics and is on dvt prophylaxis. They received 2.5mg ICG dye preop. After their abdomen was prepped and draped in a sterile fashion, time out was performed.
Initial access was obtained with a Veress needle in the left upper quadrant. The abdomen was insuflated to 15mmHg. A supraumbilical incision was made and an 8mm robotic trochar was placed through this using the Optiview. Two additional ports were placed to the patients left approximately 7cm apart and one additional port approximately 7cm to the patients right. Ports were identified as 1- patient right side, 2- umbilical camera, 3- left 7cm from camera, 4- 7cm left from port 3.
The Davinci xi robot was then docked. Instruments were inserted under direct observation as follows: fenestrated bipolar in 1, monopolar scissors in 3, Prograsp in 4.
At this point I moved to the surgeon terminal. The gallbladder fundus was retracted above the liver using the Prograsp. The infundibulum was retracted laterally using the fenestrated bipolar. The scissors were then used to dissect out the critical view.
The scissors were exchanged for a clip applier and the cystic duct was clipped with two clips distal and one proximal and cut with scissors. The cystic artery was clipped with one clip proximal and two distal and cut with scissors. The gallbladder was removed from the gallbladder bed using the scissors on cautery.
The gallbladder was placed in an endocatch bag. Robotic instruments were removed and the robot was undocked.
The gallbladder was removed through the umbilicus. The umbilical fascia was closed using 0 vicryl using carter thompson. Incisions were irrigated and closed with 4-0 monocryl. Lidocaine anesthesia was injected to incision sites.