Procedures
Laparoscopic cholecystectomy
Step-by-Step Overview
A student-level conceptual overview of the case flow -- not a procedural manual.
1
Establish pneumoperitoneum and place ports.
CO2 insufflation creates working space. Four ports are standard: umbilical (camera), epigastric, and two RUQ working ports positioned for triangulation toward the gallbladder.
2
Expose the gallbladder.
The fundus is retracted superiorly while the infundibulum is pulled laterally. Proper retraction opens Calot's triangle and reduces the risk of bile duct misidentification.
3
Dissect the hepatocystic triangle.
Fat and fibrous tissue are cleared to skeletonize the cystic duct and cystic artery. Dissect on both the anterior and posterior aspects of the triangle.
4
Confirm all three Critical View of Safety criteria.
Pause before placing any clip or dividing the cystic duct or artery. Confirm all three criteria together:
Sources:
CVS checkpoint: all three required
- The is cleared of fat and fibrous tissue.
- The lower third of the gallbladder is separated from the , exposing the plate.
- Only two structures are seen entering the gallbladder: the cystic duct and cystic artery.
Seeing two structures alone is not sufficient to establish CVS.
Reference: SAGES Safe Cholecystectomy Program5
Clip and divide the cystic duct.
Division should only occur once the Critical View is confirmed. Clips are placed proximally and distally, then the duct is divided between them.
6
Clip and divide the cystic artery.
Confirm anatomy and maintain visualization while controlling bleeding risk. The artery is clipped and divided with the same technique.
7
Separate the gallbladder from the liver bed.
Dissection proceeds along the hepatic bed using electrocautery or an energy device, with attention to bleeding and bile leakage from accessory ducts.
8
Inspect the field and remove the gallbladder.
Confirm hemostasis, inspect clips, and remove the specimen via the umbilical or epigastric port site, using a retrieval bag if needed.