Thursday, May 13, 2010

Laparoscopic Cholecystectomy: Brief overview

Gall Bladder is a Pear shaped accessory digestive organ situated just beneath the liver.It is a small organ that aids digestion and stores bile produced by the liver(It can store uptom 50 ml of bile). In humans the loss of the gallbladder is not fatal... When the concentration of cholesterol or fats increases in the bile juice it precipitates as stone in the Gall Bladder. It can occur in all age groups and in both males and females, though more commonly in females. The five F’s of Gall Bladder stone diseases are “A Fat, Flatulent, Fair, Female of Forty is more likely to have gall stones”.

Laparoscopic cholecystectomy requires 3-4 small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5-10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity(usually through the umbilical opening). The camera illuminates the surgical field and sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports.
To begin the operation, the patient is anesthetized and placed in the supine position on the operating table. A scalpel is used to make a small incision at the umbilicus. Using either a Veress needle(closed technique) or Hasson technique(open technique) the abdominal cavity is entered. The surgeon insufflates the abdominal cavity with carbon dioxide to create a working space.. Additional ports are placed inferior to the ribs at the epigastric, midclavicular, and anterior axillary positions. The gallbladder fundus is identified, grasped, and retracted superiorly. With a second grasper, the gallbladder infundibulum is retracted laterally to expose and open Calot's Triangle (the area bound by the cystic artery, cystic duct, and common hepatic duct). The triangle is gently dissected and then the cystic duct and the cystic artery are identified, clipped with tiny clips and cut. Then the gallbladder is dissected away from the liver bed and removed through one of the ports. This type of surgery requires meticulous surgical skill, but in straightforward cases can be done in about an hour.

Recently, this procedure is performed through a single incision in the patient's umbilicus. This advanced technique is called Laparoendoscopic Single Site Surgery or "LESS".

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