Laparoscopic cholecystectomy

PREOPERATIVE DIAGNOSES:  Biliary colic and chronic  cholecystitis.

POSTOPERATIVE DIAGNOSES:  Biliary colic and chronic cholecystitis.

PROCEDURE:  Laparoscopic cholecystectomy.

ANESTHESIA:  General.

INDICATIONS:  The patient is a 41-year-old white female admitted yesterday with complaints of right upper quadrant abdominal pain.  She was found to have gallstones.  Plans were made for surgery.  She is aware of the procedure, risks, benefits, and alternatives and agreed to proceed.

PROCEDURE:  The patient was taken to the operating room and placed in the supine position.  After general endotracheal anesthesia was administered, her abdomen was prepped and draped in the usual sterile fashion.  The knife was used to make a small infraumbilical incision.  Dissection was taken down through the fascia.  It was incised sharply.  Figure-of-eight suture with 0 Vicryl was placed and blunt dissection accomplished in the peritoneal cavity.  The Hasson port was placed and CO2 insufflated until a pressure of 15 was reached.  Under direct vision, a 5-mm port was placed below the xiphoid and another 5-mm port below the costal margin on the right side.

The gallbladder was retracted cephalad.  There were some minor adhesions, which were taken down using careful blunt dissection.  Dissection continued at the neck of the gallbladder.  The cystic duct was identified and isolated.  Its junction with the gallbladder and common duct were noted.  Two clips were applied on the cystic duct proximally and one distally, and the duct divided.  The same was done with the cystic artery.  Electrocautery was used to separate the gallbladder from the liver bed.  It was placed into an Endopouch and later removed through the umbilical port site.  The liver bed was irrigated with saline and suctioned dry.  Hemostasis was good.

All instruments were withdrawn.  CO2 was allowed to escape.  Fascia of the umbilicus was closed with 0 Vicryl and all skin incisions with 4-0 Monocryl subcuticular sutures.  Steri-Strips and Tegaderm dressings were applied.  The patient tolerated the procedure well and there were no complications.  She was sent to recovery in stable condition.