Laparoscopic cholecystectomy is now a routine procedure for gallbladder surgery and the gold standard for cholecystectomy. Learn about the operating steps, key points and difficulties of laparoscopic gallbladder surgery in one article.

Specific operation steps of the surgery
STEP 1: The first incision is made in the umbilicus to insert the trocar and place the camera.

STEP 2: The remaining three incisions are made in the upper abdomen and the trocar is inserted.

STEP 3: Locate the gallbladder and grasp it with a clamp.

STEP 4: Peel away the fat to reveal two important structures - the gallbladder duct and the gallbladder artery.

STEP 5: Clamp off and cut the gallbladder duct and gallbladder artery.
Picture

STEP 6: Begin peeling the gallbladder off the back of the liver.

STEP 7: Move gently until the gallbladder is completely stripped.
Picture

STEP 8: Put the gallbladder into this small bag and remove it through the incision in the upper abdomen.

STEP 9: Gallbladder stones

Key points and difficulties in laparoscopic cholecystectomy

Good visualization of the surgical field is a prerequisite for the correct management of the structures within the Calot's triangle. Correct management of the structures within the Calot's triangle is the key to completing cholecystectomy, and the quality of the management is directly related to the patient's prognosis.

1、Good visualization of Calot's triangle
① Position of abdominal wall poke holes
After inserting the laparoscope to understand the position of the liver, the right side of the falciform ligament under the xiphoid process should be poked perpendicularly or slightly lower than the lower edge of the liver. The distance between the poked hole under the xiphoid process and the poked hole in the right midclavicular line should be about 10cm, and the poked hole under the rib margins of the midclavicular and axillary front lines should be slightly lower than the lower edge of the liver.
② position, pneumoperitoneum pressure changes
For those with more intra-abdominal fat, poor intestinal preparation and gastrointestinal distension, the greater omentum, gastrointestinal tube upward displacement of the subhepatic hiatus narrowing, poor exposure of the Calot triangle, at this time, you can appropriately increase the intra-abdominal pressure to 15mmHg, the patient will be placed in a head-high, foot-low position and tilted to the left at 15 degrees, with the help of the gravity of the above organs and adipose tissue, in order to increase the widening of subhepatic hiatus, increase the operating space.

2、Dissection and treatment of tissues in Calot's triangle
Calot's triangle should be opened as much as possible, and the periphery of the juxta-peritoneum of the gallbladder and the confluence of the cystic duct should be fully freed to clearly show its internal structure.

3、Correctly grasp the timing of mid-rotation laparotomy to reduce complications
Laparoscopic surgery, because of its special surgical environment and high dependence on the operator's operating technique and equipment performance, reveals its limitations and some potential dangers unique to it from the beginning, so it cannot completely reach the realm of open surgery.