Procedures
Laparoscopic cholecystectomy
One-Minute Overview
Indications
Symptomatic cholelithiasis, acute cholecystitis, biliary colic, and cholecystectomy during the same admission after mild gallstone pancreatitis improves.
Positioning
Supine. Reverse Trendelenburg with slight left tilt to expose the gallbladder.
Key Anatomy to Know Cold
Hepatocystic triangle (cystic duct, common hepatic duct, inferior liver edge), cystic artery, common bile duct.
Critical Concept -- Critical View of Safety (CVS)
CVS criteria -- confirm all three before clipping or dividing
- Clear fat and fibrous tissue from the hepatocystic triangle
- Dissect the lower third of the gallbladder off the liver bed
- Confirm only two structures enter the gallbladder (cystic duct and cystic artery)
Failure to achieve CVS risks misidentifying the common bile duct as the cystic duct -- the most common cause of bile duct injury.
Major Complications
Bile duct injury, bleeding (cystic artery or liver bed), bile leak, retained stones, surgical site infection.