Laparoscopic cholecystectomy

Why are we operating?

Removal of the gallbladder through ports, built around one idea: never divide a structure until the Critical View of Safety proves what it is.

Indication: Symptomatic gallstones, cholecystitis, biliary dyskinesia, gallstone pancreatitis after recovery.

The operation in 6 steps

1. 01Access & insufflation

2. 02Exposure

3. 03Critical View of Safety

4. 04Clip & divide

5. 05Gallbladder off the liver bed

6. 06Extraction & closure

Danger zones

• Common bile duct

  Inflammation shortens and tents the cystic duct until the common duct can masquerade as it; the classic injury is clipping and dividing the wrong duct with complete confidence.

• Right hepatic artery

  Often loops close to the cystic artery; injury can devascularise the right liver.

• Duodenum

  Sits just below the porta, thermal injury from diathermy can present days later as a leak.