Laparoscopic Cholecystectomy as seen through laparoscope

X-Ray during Laparoscopic Cholecystectomy

Cholecystectomy (/ˌkɔləsɪsˈtɛktəmi/, plural: cholecystectomies,) is the surgical removal of the gallbladder. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process Despite the development of non-surgical techniques, it is the most common method for treating symptomatic gallstones, although there are other reasons for having this surgery done. In Medicine, gallstones (choleliths are Crystalline bodies formed within the body by accretion or concretion of normal or abnormal Bile component Each year more than 500,000 Americans have gallbladder surgery. Surgery options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. Laparoscopic surgery, also called Minimally invasive surgery (MIS, bandaid surgery, Keyhole surgery, or pinhole surgery A cholecystectomy is performed when attempts to treat gallstones with ultrasound to shatter the stones or medications to dissolve them have not proved feasible.

Open surgery

Traditional open cholecystectomy is a major abdominal surgery in which the surgeon removes the gallbladder through a 4- to 7-inch (10 to 18 cm) incision. Patients usually remain in the hospital over night and may require several additional weeks to recover at home.

Laparoscopic surgery

Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first-choice of treatment for gallstones unless there are contraindications to the laparoscopic approach. In Medicine, gallstones (choleliths are Crystalline bodies formed within the body by accretion or concretion of normal or abnormal Bile component Sometimes a laparoscopic cholecystectomy will be converted to an open cholecystectomy for technical reasons or safety.

Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of surgical instruments and a small video camera. After the initial incisions, the surgeon will inflate the abdominal cavity with carbon dioxide. The camera 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 separate small incisions. The gallbladder is identified and carefully Calot's Triangle (the area bound by the inferior wall of the liver, cystic duct, and hepatic duct) is cleared. The hepatobiliary triangle (or cystohepatic triangle) is an anatomic space bordered by the Common hepatic duct medially the Cystic duct inferiorly and The cystic duct is the short Duct that joins the Gall bladder to the Common bile duct. The common hepatic duct is the duct formed by the convergence of the Right hepatic duct (which drains bile from the Right functional lobe of the liver) and the The cystic duct and the cystic artery are identified, clipped with tiny titanium clips and cut. The cystic duct is the short Duct that joins the Gall bladder to the Common bile duct. The cystic artery supplies oxygenated blood to the Gallbladder and Cystic duct. Then the gallbladder is separated from the liver bed and removed through one of the small incisions. 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 belly-button. This advanced technique is called as Single Port Access Surgery. Single Port Access (SPATM surgery also known as Single Incision Laparoscopic Surgery (SILSTM or One Port Umbilical Surgery (OPUS or Natural Orifice TransUmbilical

Laparoscopic cholecystectomy does not require the abdominal muscles to be cut, resulting in less pain, quicker healing, improved cosmetic results, and fewer complications such as infection. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the An infection is the detrimental Colonization of a host Organism by a foreign Species. Most patients can be discharged on the same or following day as the surgery, and most patients can return to any type of occupation in about a week. However, 20% of patients experience chronic diarrhea following surgury, which may persist for weeks or years. [1]

Complications

An uncommon but potentially serious complication with the new procedure is injury to the common bile duct, which connects the gallbladder and liver. Bile, which is synthesized in the liver is carried to the right and left hepatic ducts which converge along with the Cystic duct to form the Common hepatic duct. An injured bile duct can leak bile and cause a painful and potentially dangerous infection. Many cases of minor injury to the common bile duct can be managed non-surgically. Major injury to the bile duct, however, is a very serious problem and may require corrective surgery.

Abdominal peritoneal adhesions, gangrenous gallbladders, and other problems that obscure vision are discovered during about 5% of laparoscopic surgeries, forcing surgeons to switch to the standard cholecystectomy for safe removal of the gallbladder. Converting to open surgery does not equate to a complication.

A Consensus Development Conference panel, convened by the National Institutes of Health in September 1992, endorsed laparoscopic cholecystectomy as a safe and effective surgical treatment for gallbladder removal, equal in efficacy to the traditional open surgery. "NIH" redirects here For other meanings of NIH see NIH (disambiguation. The panel noted, however, that laparoscopic cholecystectomy should be performed only by experienced surgeons and only on patients who have symptoms of gallstones.

In addition, the panel noted that the outcome of laparoscopic cholecystectomy is greatly influenced by the training, experience, skill, and judgment of the surgeon performing the procedure. Therefore, the panel recommended that strict guidelines be developed for training and granting credentials in laparoscopic surgery, determining competence, and monitoring quality. According to the panel, efforts should continue toward developing a noninvasive approach to gallstone treatment that will not only eliminate existing stones, but also prevent their formation or recurrence.

One common complication of Cholecystectomy is an anomaly known as Ducts of Luschka, occurring in 33% of the population. An accessory Bile duct is a Conduit that transports Bile and is considered to be Supernumerary or auxiliary to the Biliary tree. It is non-problematic until the gall bladder is removed, and the tiny supravesicular ducts may be incompletely cauterized or remain unobserved, leading to biliary leak post operatively. The patient will develop biliary peritonitis within 5 to 7 days following surgery, and will require a temporary biliary stent. It is important that the clinician recognize the possibility of bile peritonitis early and confirm diagnosis via HIDA scan to lower morbidity rate. Aggressive pain management and antibiotic therapy should be initiated as soon as diagnosed.