Laparoscopic Cholecystectomy Research Paper
Laparoscopic Cholecystectomy with Cholangiogram A laparoscopic cholecystectomy with cholangiograms is the surgical procedure of removing the gallbladder. Removal of the gallbladder can be due to several reasons including gallstones, tumors, cancer, damage to gallbladder, gallstone disease, etc. This “has rapidly become the procedure of choice for routine gallbladder removal and is currently the most commonly performed major abdominal procedure in Western countries”. (MED) Laparoscopic has become the procedure of choice compared to a noninvasive approach due to decrease in pain, shortened duration of time spent in the hospital, quicker recovery rate, and for cosmetic purposes. What was a procedure for young thin patients is now acceptable
…show more content…
for the elderly and obese patients as well. This decreases the risk for complications and typically has a positive outcome.
Patient condition The patient was a fifty-six year old female with right upper quadrant pain. She was scheduled for surgery two months prior but said she felt better and eventually canceled the surgery. She had a history of multiple gallstones and the symptoms returned to the point where she went through with the surgery. Previous to the surgery she had a c section with one of her children causing a scar to run lateral to the belly button which in turn caused the surgeon to be extremely careful making the first incision as to not reopen the scar.
Procedure
Before the surgery begins preoperative antibiotics are given to the patient to reduce the risk of infection but does not prevent it.
The patient is placed in the standard supine position and prepped for surgery. Once started the surgeon makes an incision inside the belly button and inserts a five mm trocar (device used to keep open a hole so devices can be inserted into the body). Once the trocar is inserted and placed into the belly button the surgeon will inflate a balloon used to raise the abdomen. The balloon is inserted and filled with CO2. A fifteen blade is used to make an incision for the epigastric trocar placement which is inserted to the right of the falciform ligament. A third trocar is placed lateral to the epigastric artery and a grasper is inserted into it in order to keep the gallbladder in place. A second one is inserted and is used to dissect the fatty tissue in order to expose the cystic duct and artery. Once located they are clipped with a clip applier as to help prevent damage and bleeding. A glangio catheter is inserted into the abdomen manually and inserted into the cystic duct and a second clip is placed. Once that is complete the cystic duct is then clipped with a straight dissector and the catheter is inserted into the duct in order to flush out with dye. The dye is used to examine the duct and once cleared the catheter is removed and the clip is left in place. Another clip is then placed blow that one on the patient side and the cystic duct is cut
in half horizontally. The same thing is done with the cystic artery so both are dissected and divided. Once this has occurred the surgeon is now free to dissect the gallbladder off of the liver bed. This is done by taking a spatula carterisor and carterising the tissue as to not cause bleeding. Once completely removed the surgeon checks for bleeding and the gallbladder is placed in a bag inside the abdomen. A string is tied around the bag, which is also used to remove the bag from the abdomen, and closed. The remaining trocars are removed and the balloon is deflated. Once done they pull on the string and remove the bag with the gallbladder inside. The surgeon checks the incisions made in the beginning of the procedure and sews together the one in the belly button using dissolvable stiches. The holes remaining where the trocars were place are small enough that they should heal on their own and don’t need stiches. (video)
What was found to be most interesting What I found to be most interesting was the fact that the spatula carterisor the surgeon used could also flush out the surrounding area and could be used for suction as well. The multipurpose tool was interesting due to the fact that I had never seen one be able to do three different things at once. I am currently in school to be a surgical nurse so I spend a lot of free time watching surgeries and typically see them using three separate tools for what he could do in one.
for the elderly and obese patients as well. This decreases the risk for complications and typically has a positive outcome.
Patient condition The patient was a fifty-six year old female with right upper quadrant pain. She was scheduled for surgery two months prior but said she felt better and eventually canceled the surgery. She had a history of multiple gallstones and the symptoms returned to the point where she went through with the surgery. Previous to the surgery she had a c section with one of her children causing a scar to run lateral to the belly button which in turn caused the surgeon to be extremely careful making the first incision as to not reopen the scar.
Procedure
Before the surgery begins preoperative antibiotics are given to the patient to reduce the risk of infection but does not prevent it.
The patient is placed in the standard supine position and prepped for surgery. Once started the surgeon makes an incision inside the belly button and inserts a five mm trocar (device used to keep open a hole so devices can be inserted into the body). Once the trocar is inserted and placed into the belly button the surgeon will inflate a balloon used to raise the abdomen. The balloon is inserted and filled with CO2. A fifteen blade is used to make an incision for the epigastric trocar placement which is inserted to the right of the falciform ligament. A third trocar is placed lateral to the epigastric artery and a grasper is inserted into it in order to keep the gallbladder in place. A second one is inserted and is used to dissect the fatty tissue in order to expose the cystic duct and artery. Once located they are clipped with a clip applier as to help prevent damage and bleeding. A glangio catheter is inserted into the abdomen manually and inserted into the cystic duct and a second clip is placed. Once that is complete the cystic duct is then clipped with a straight dissector and the catheter is inserted into the duct in order to flush out with dye. The dye is used to examine the duct and once cleared the catheter is removed and the clip is left in place. Another clip is then placed blow that one on the patient side and the cystic duct is cut
in half horizontally. The same thing is done with the cystic artery so both are dissected and divided. Once this has occurred the surgeon is now free to dissect the gallbladder off of the liver bed. This is done by taking a spatula carterisor and carterising the tissue as to not cause bleeding. Once completely removed the surgeon checks for bleeding and the gallbladder is placed in a bag inside the abdomen. A string is tied around the bag, which is also used to remove the bag from the abdomen, and closed. The remaining trocars are removed and the balloon is deflated. Once done they pull on the string and remove the bag with the gallbladder inside. The surgeon checks the incisions made in the beginning of the procedure and sews together the one in the belly button using dissolvable stiches. The holes remaining where the trocars were place are small enough that they should heal on their own and don’t need stiches. (video)
What was found to be most interesting What I found to be most interesting was the fact that the spatula carterisor the surgeon used could also flush out the surrounding area and could be used for suction as well. The multipurpose tool was interesting due to the fact that I had never seen one be able to do three different things at once. I am currently in school to be a surgical nurse so I spend a lot of free time watching surgeries and typically see them using three separate tools for what he could do in one.