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Procedure of laparoscopic cholecystectomy

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Procedure of laparoscopic cholecystectomy

Date of issue:2021-08-25 author: click:


 

On September 12, 1985, the first laparoscopic cholecystectomy was performed in Muhe, Germany. It took about 2 hours and proved to be feasible and safe compared with open surgery. At present, laparoscopic cholecystectomy is the gold standard of cholecystectomy !

Surgical indications

Multiple gallstones or symptomatic gallstones, gallbladder polyps larger than 1 cm, gallbladder adenomyosis, etc.

 

Key surgical steps

 

1 Position and Trocar layout: supine position (head high, feet low, right side too high), trocar layout is the common three-hole or four-hole method.

 

2 Exploration of abdominal cavity: if the gallbladder inflammation is severe, you can first dissociate the gallbladder and separate the adhesion around the gallbladder.

 

3 Anatomy of anterior and posterior gallbladder triangle:

Rouviere's Sulcus was proposed by Henri Rouviere in 1924 and can be seen in 82% of patients. It is a groove of about 2-5 cm located on the right side of the first hilum, in which there is usually a right posterior or right hepatic Glingson system walking. It is a good anatomical marker to distinguish the common bile duct plane. Rouvieres groove points to the neck of the gallbladder, and the connection between the 4th and 5th segments of the liver base is the anterior and posterior triangle dissection path, which can effectively avoid damage to the common bile duct and the hepatic duct.

 

4 CVS technology identifies the gallbladder artery and gallbladder duct:

图片1.png

 

American Professor Strasberg first proposed THE CVS technique in 1995, emphasizing that the gallbladder duct and gallbladder artery are the only two channels that enter the gallbladder. The technical details include the complete hollowing of the gallbladder triangle, the lower 1/3 of the gallbladder bed is free, and the gallbladder duct, gallbladder artery and the lower part of the gallbladder bed can be seen. The gallbladder duct and gallbladder artery were distinguished without any clipper dissection, and free exposure of the common bile duct was not required.

 

5 Debridement of the gallbladder artery: According to the thickness of the artery, direct debridement with electric hook/ultrasonic knife or hemlock is selected.

 

6 Dissection of the gallbladder duct: Hemlock is usually used, with 2 proximal and 1 distal.

 

7 Gallbladder removal: it is recommended to use an extract bag to reduce the infection rate of puncture hole.

 

8 Check for common bile duct injury, gallbladder bed bleeding, etc. Indwelling abdominal drainage tube if necessary.

 

9 Remove the casing and close the incision.


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key word:Procedureoflaparoscopiccholecystectomy

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