Surgical Procedures

Laparoscopic Cholecystectomy

Miguel A. Burch, MD analyzes a laparoscopic cholecystectomy as he operates on a 25-year-old patient with chronic right upper quadrant pain and no evidence of stones on her ultrasound and other imaging.
Miguel A. Burch, MD
General Surgery

Background Information: Cholecystectomy is the surgical removal of the gallbladder. This procedure may be performed via the open procedure or minimally invasive (laparoscopic or robotic). 


Indications: 

  • Acute Cholecystitis
  • Symptomatic cholelithiasis (biliary colic)
  • Choledocholithiasis
  • Gallbladder pancreatitis
  • Gallstone ileus
  • Mirizzi Syndrome
  • Gallbladder cancer
  • Gallbladder polyps >1cm
  • Porcelain gallbladder 


Key Anatomy:

  • Gallbladder
  • Fundus
  • Body
  • Neck
  • Infundibulum
  • Triangle of Calot (hepatocystic triangle)
  • Calot's (cystic) lymph node
  • Cystic artery
  • Cystic duct
  • Common bile duct
  • Common hepatic duct
  • Rouviere's sulcus


Surgical Risks:

General surgical risks:

  • Bleeding
  • Infection


Risks specific to Cholecystectomy:

  • Common bile duct injury (0.22% incidence for laparoscopic repairⁱ)
  • Bile leak from the transected cystic duct (0.5% incidence for laparoscopic repairⁱ)
  • Enterotomy
  • 0.22% incidence for laparoscopic surgery²
  • Postoperative ileus
  • Risk lower for minimally invasive procedures vs. open


Additional Resources:


American College of Surgeons/Association for Surgical Education Core Curriculum


Osmosis:


Online MedEd:


Text:

  • Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice by Courtney M. Townsend Jr. JR. MD
  • Zollinger's Atlas of Surgical Operations, Tenth Edition 10th Edition by Robert Zollinger, E. Ellison 
  • Atlas of General Surgical Techniques: Townsend, Evers
  • Essentials of General Surgery 5th Edition, by Peter F. Lawrence MD, Richard M. Bell MD, Merril T. Dayton MD, James C. Hebert MD FACS


Other:



References:

  • Fong ZV, Pitt HA, Strasberg SM, et al. Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes. J Am Coll Surg. 2018;226(4):568-576.e1. doi:10.1016/j.jamcollsurg.2017.12.023
  • van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg. 2004;91(10):1253-1258. doi:10.1002/bjs.4716



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