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Name:
Laparoscopic Cholecystectomy
Description:
Laparoscopic Cholecystectomy
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/efab82ec-b3fd-4210-becf-cf608d65ee84/thumbnails/efab82ec-b3fd-4210-becf-cf608d65ee84.jpg?sv=2019-02-02&sr=c&sig=wv5YBK5bl5KCRpdc8pZGGToFyH2lFlM0hWw%2FjqTcv9E%3D&st=2025-05-13T11%3A10%3A15Z&se=2025-05-13T15%3A15%3A15Z&sp=r
Duration:
T00H07M01S
Embed URL:
https://stream.cadmore.media/player/efab82ec-b3fd-4210-becf-cf608d65ee84
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/efab82ec-b3fd-4210-becf-cf608d65ee84/Laparoscopic20Cholecystectomy.mp4?sv=2019-02-02&sr=c&sig=iXM3%2Fad28iSrxO%2BVWzKDQZjqi8T6Cl%2FWYAfNUhWBKG8%3D&st=2025-05-13T11%3A10%3A15Z&se=2025-05-13T13%3A15%3A15Z&sp=r
Upload Date:
2022-03-18T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 Clinical Presentation.
I'm Francis Charles Brunicardi, Professor and Vice Chairman of the Department of Surgery at the David Geffen School of Medicine at UCLA. The patient is a 52-year-old man who was admitted with one day of progressive right upper quadrant pain associated with nausea and vomiting. The workup was consistent with severe biliary colic. The ultrasound revealed gallstones. The gallbladder wall was 2.4 millimeters in thickness, and the common bile duct was 4.2 millimeters in diameter.
The bilirubin was 2.5. However, the AST, ALT, and GGT were all within normal limits. His amylase was 17, and his lipase was 33. The white count was 9.3 with a left shift of 90% neutrophils. The different options were discussed with the patient, and he wished to have a laparoscopic cholecystectomy with an intraoperative cholangiogram. He understood the risks and benefits of the operation and gave consent to have the procedure recorded.
The patient was prepared for the operating room with resuscitation using IV fluids and antibiotics.
Segment:2 Patient Positioning.
The patient was brought into the operating room, prepped and draped in the usual manner, under general anesthesia, with his arms extended. As the operating surgeon, I prefer to stand on the patient's right side, and the residents stand on the left side.
Segment:3 Abdominal Cavity Exploration.
A vertical incision is made in the midline of the umbilicus.
The umbilical stalk is cut circumferentially, and the blunt trocar is placed into the umbilical ring. The abdominal cavity is insufflated with CO2 gas, and an exploration is performed. The gallbladder was seen to be dilated and mildly inflamed. There were chronic inflammatory changes of the sigmoid colon to the left lower quadrant. However, no other lesions were seen within the abdominal cavity.
Segment:4 Trocar Placement and Surgery Begins.
Three 5-millimeter VersaStep ports were placed in the right upper quadrant under direct camera vision. It is to be noted that my left hand is used to guide the trajectory of the port as it's placed within the abdominal cavity. Once the ports are placed, the gallbladder is lifted cephalad. I prefer to drain the gallbladder of its bile, making it a much easier dissection.
Once the bile is completely drained from the gallbladder, the adhesions are taken down using sharp and blunt dissection. It is my preference to use a Kittner dissector to take down the adhesions. The structures of the porta are carefully identified, including the hepatic artery, the common bile duct, as well as the cystic artery and it's junction with the common bile duct.
The triangle of Calot is then dissected using the Kittner. It is important to retract the gallbladder 90 degrees to the common bile duct to ensure that there is no injury to the common bile duct. The common bile duct is identified in the right lower quadrant. The cystic duct is seen, as well as the cystic artery.
Segment:5 Cholangiogram Performed.
A cholangiogram is performed by making an incision into the cystic duct at its junction with the gallbladder.
The cystic duct is then palpated using the Maryland dissector to be sure there are no small stones lodged within the cystic duct. The cholangiogram catheter is then placed into the cystic duct and clamped. The patient is rolled to the right side to ensure that the common bile duct is removed away from the spine. 50% Hypaque dye is placed into the common bile duct.
It can be seen to be normal in caliber. There are no stones present, and there is free flow of contrast into the duodenum.
Segment:6 Division of Cystic Duct and Artery.
Once the catheter is removed, the anatomy then is reviewed and clips are placed using a 5-millimeter clip applier. The cystic duct is then severed. The cystic artery is then carefully dissected. Two clips are placed proximally and one clip is placed distally, and the cystic artery is severed.
It is important to carefully dissect the porta at this point for a posterior cystic artery. The posterior cystic artery is seen being clipped. Great care is also taken to look for any ducts of Luschka that might be emanating from the hepatic bed into the gallbladder.
Segment:7 Dissection of Gallbladder from Bed.
The spatula is hooked to the suction irrigator, which is a nice technique which permits irrigating of the hepatic bed and suctioning of the smoke.
It is important to prevent the smoke from exiting the abdominal cavity into the room. Great care is taken to remain in the plane between the gallbladder and the hepatic bed to avoid injury to both the gallbladder as well as the hepatic bed. Vessels are cauterized. Once the dissection is completed, a 5-millimeter camera is placed in a lateral port, and the Endocatch is placed into the umbilical port.
The hepatic bed is irrigated. Hemostasis is achieved. The right upper quadrant is irrigated.
Segment:8 Closure.
The trocars are removed under direct camera vision to ensure that there's no bleeding from the trocar sites. The umbilical trocar site is closed using three or four interrupted sutures of 0 Vicryl. The skin is closed with 4-0 Monocryl. The wounds are then covered with Steri-Strips and sterile dressings.
The patient was taken to the recovery room in excellent condition having tolerated the procedure well, and was discharged on post-operative day one.
Language: ES.
Segment:1 Clinical Presentation.
Soy Francis Charles Brunicardi, profesor y vicepresidente del Departamento de Cirugía en la Escuela de Medicina David Geffen de la UCLA. El paciente es un varón de 52 años, admitido por presentar dolor progesivo en el cuadrante superior derecho, asociado con náuseas y vómito. El cuadro coincidía con un cólico biliar grave. El ultrasonido mostró cálculos biliares. La pared de la vesícula biliar era de 2.4 milímetros de grosor, y el conducto biliar común tenía 4.2 milímetros de diámetro.
La bilirrubina era 2.5 Sin embargo las AST, ALT y GGT estaban dentro de la normalidad. Su amilasa era 17 y la lipasa 33. El recuento de leucocitos era 9.3 con un cambio hacia la izquierda de 90% de neutrófilos. Se discutieron las diferentes opciones con el paciente, y eligió la colecistectomía laparoscópica con una colangiografía intraoperatoria. Entendió los riesgos y beneficios de la operación y dio su consentimiento para grabar el procedimiento.
Se preparó al paciente para la la sala de operaciones con resucitación mediante el uso de fluidos IV y antibióticos.
Segment:2 Patient Positioning.
Se llevó al paciente al quirófano, preparado y cubierto de la manera habitual, bajo anestesia general con los brazos extendidos. Como cirujano, prefiero colocarme a la derecha del paciente, y que los residentes se sitúen a la izquierda.
Segment:3 Abdominal Cavity Exploration.
Se realiza una incisión vertical en la línea media del ombligo.
Se corta el tallo umbilical en circunferencia y el trocar romo se introduce en el anillo umbilical. La cavidad abdominal se infla con gas CO2 y se realiza la exploración. Se aprecia que la vesícula biliar está dilatada y algo inflamada. Había cambios inflamatorios crónicos en el cuadrante inferior izquierdo del colon sigmoideo. No se apreciaron más lesiones en la cavidad abdominal.
Segment:4 Trocar Placement and Surgery Begins.
Se colocaron tres puertos VersaStep de 5 milimetros en el cuadrante superior derecho bajo visón directa de la cámara. Es importante señalar que uso la mano izquierda para guiar la trayectoria del puerto al colocarlo en la cavidad abdominal. Una vez colocados los puertos, la vesícula biliar se levanta cefálicamente. Prefiero vaciar la vesícula de bilis, eso hace la disección más fácil.
Una vez que ya no hay bilis en la vesícula biliar, se liberan las adherencias mediante una disección de corte filo y tambien romo. Prefiero usar el disector de Kittner para liberar las adherencias. Las estructuras de la porta son cuidadosamente identificadas, incluidas la arteria hepática, el conducto biliar común, así como la arteria cística y su unión con el conducto biliar común.
Luego se disecciona el triángulo de Calot con el Kittner. Es importante replegar la vesícula biliar 90 grados hacia el conducto biliar común para asegurarse de que no hay lesión en el conducto biliar común. Se identifica el conducto biliar común en el cuadrante inferior derecho. Se ven el conducto cístico y la arteria cística.
Segment:5 Cholangiogram Performed.
Se realiza una colangiografía, haciendo una incisión en el conducto cístico en la unión con la vesícula biliar.
Se palpa entonces el conducto cístico usando el disector de Maryland para asegurarse de que no hay pequeñas piedras alojadas en el conducto cístico. Después se coloca el catéter de colangiografía en el conducto cístico y se grapa. Se pone al paciente sobre el lado derecho para asegurarse de que el conducto biliar común se separa de la espina. Se inyecta el contraste Hypaque al 50%. en el conducto biliar común.
Se puede ver que es normal en calibre. No hay presencia de piedras y hay un flujo de contraste libre en el duodeno.
Segment:6 Division of Cystic Duct and Artery.
Una vez que se retira el catéter se revisa entonces la anatomía y se colocan clips usando un aplicador de clips de 5 mm. Se corta el conducto cístico. Luego se disecciona cuidadosamente la arteria cística. Se colocan dos clips proximales y un clip distal y se corta la arteria cística.
Es importante diseccionar cuidadosamente la porta en este punto para la arteria cística posterior. Se ve como se recorta la arteria cística posterior. Se pone cuidado en buscar cualquier conducto de Luschka que pueda emanar del lecho hepático en la vesícula biliar.
Segment:7 Dissection of Gallbladder from Bed.
La espátula se engancha al irrigador de succión, que es una buena técnica que permite irrigar el lecho hepático y aspirar el humo.
Es importante prevenir que el humo salga de la cavidad abdominal hacia la habitación. Se presta mucha atención en permanecer en el plano entre la vesícula biliar y el lecho hepático para evitar lesiones en la vesícula biliar y en el lecho hepático. Se cauterizan los vasos. Una vez completada la disección, se coloca una cámara de 5mm en un puerto lateral, y se coloca una Endocatch en el puerto umbilical.
Se irriga el lecho hepático. Se logra la hemostasia. Se irriga el cuadrante superior derecho.
Segment:8 Closure.
Se retiran los trocares bajo visión directa de la cámara para asegurarse de que no hay sangre en los otros sitios de los trocares. Se cierra el sitio del trocar umbilical con tres o cuatro suturas interrumpidas de 0 Vicryl. Se cierra la piel con Monocryl 4-0. Las heridas se cubren con Steri-Strips y gasas estériles.
Se llevó al paciente a la sala de recuperación en condición excelente. Toleró bien el procedimiento, y fue dado de alta un día después de la operación.
Segment:1 Clinical Presentation.
I'm Francis Charles Brunicardi, Professor and Vice Chairman of the Department of Surgery at the David Geffen School of Medicine at UCLA. The patient is a 52-year-old man who was admitted with one day of progressive right upper quadrant pain associated with nausea and vomiting. The workup was consistent with severe biliary colic. The ultrasound revealed gallstones. The gallbladder wall was 2.4 millimeters in thickness, and the common bile duct was 4.2 millimeters in diameter.
The bilirubin was 2.5. However, the AST, ALT, and GGT were all within normal limits. His amylase was 17, and his lipase was 33. The white count was 9.3 with a left shift of 90% neutrophils. The different options were discussed with the patient, and he wished to have a laparoscopic cholecystectomy with an intraoperative cholangiogram. He understood the risks and benefits of the operation and gave consent to have the procedure recorded.
The patient was prepared for the operating room with resuscitation using IV fluids and antibiotics.
Segment:2 Patient Positioning.
The patient was brought into the operating room, prepped and draped in the usual manner, under general anesthesia, with his arms extended. As the operating surgeon, I prefer to stand on the patient's right side, and the residents stand on the left side.
Segment:3 Abdominal Cavity Exploration.
A vertical incision is made in the midline of the umbilicus.
The umbilical stalk is cut circumferentially, and the blunt trocar is placed into the umbilical ring. The abdominal cavity is insufflated with CO2 gas, and an exploration is performed. The gallbladder was seen to be dilated and mildly inflamed. There were chronic inflammatory changes of the sigmoid colon to the left lower quadrant. However, no other lesions were seen within the abdominal cavity.
Segment:4 Trocar Placement and Surgery Begins.
Three 5-millimeter VersaStep ports were placed in the right upper quadrant under direct camera vision. It is to be noted that my left hand is used to guide the trajectory of the port as it's placed within the abdominal cavity. Once the ports are placed, the gallbladder is lifted cephalad. I prefer to drain the gallbladder of its bile, making it a much easier dissection.
Once the bile is completely drained from the gallbladder, the adhesions are taken down using sharp and blunt dissection. It is my preference to use a Kittner dissector to take down the adhesions. The structures of the porta are carefully identified, including the hepatic artery, the common bile duct, as well as the cystic artery and it's junction with the common bile duct.
The triangle of Calot is then dissected using the Kittner. It is important to retract the gallbladder 90 degrees to the common bile duct to ensure that there is no injury to the common bile duct. The common bile duct is identified in the right lower quadrant. The cystic duct is seen, as well as the cystic artery.
Segment:5 Cholangiogram Performed.
A cholangiogram is performed by making an incision into the cystic duct at its junction with the gallbladder.
The cystic duct is then palpated using the Maryland dissector to be sure there are no small stones lodged within the cystic duct. The cholangiogram catheter is then placed into the cystic duct and clamped. The patient is rolled to the right side to ensure that the common bile duct is removed away from the spine. 50% Hypaque dye is placed into the common bile duct.
It can be seen to be normal in caliber. There are no stones present, and there is free flow of contrast into the duodenum.
Segment:6 Division of Cystic Duct and Artery.
Once the catheter is removed, the anatomy then is reviewed and clips are placed using a 5-millimeter clip applier. The cystic duct is then severed. The cystic artery is then carefully dissected. Two clips are placed proximally and one clip is placed distally, and the cystic artery is severed.
It is important to carefully dissect the porta at this point for a posterior cystic artery. The posterior cystic artery is seen being clipped. Great care is also taken to look for any ducts of Luschka that might be emanating from the hepatic bed into the gallbladder.
Segment:7 Dissection of Gallbladder from Bed.
The spatula is hooked to the suction irrigator, which is a nice technique which permits irrigating of the hepatic bed and suctioning of the smoke.
It is important to prevent the smoke from exiting the abdominal cavity into the room. Great care is taken to remain in the plane between the gallbladder and the hepatic bed to avoid injury to both the gallbladder as well as the hepatic bed. Vessels are cauterized. Once the dissection is completed, a 5-millimeter camera is placed in a lateral port, and the Endocatch is placed into the umbilical port.
The hepatic bed is irrigated. Hemostasis is achieved. The right upper quadrant is irrigated.
Segment:8 Closure.
The trocars are removed under direct camera vision to ensure that there's no bleeding from the trocar sites. The umbilical trocar site is closed using three or four interrupted sutures of 0 Vicryl. The skin is closed with 4-0 Monocryl. The wounds are then covered with Steri-Strips and sterile dressings.
The patient was taken to the recovery room in excellent condition having tolerated the procedure well, and was discharged on post-operative day one.
Language: ES.
Segment:1 Clinical Presentation.
Soy Francis Charles Brunicardi, profesor y vicepresidente del Departamento de Cirugía en la Escuela de Medicina David Geffen de la UCLA. El paciente es un varón de 52 años, admitido por presentar dolor progesivo en el cuadrante superior derecho, asociado con náuseas y vómito. El cuadro coincidía con un cólico biliar grave. El ultrasonido mostró cálculos biliares. La pared de la vesícula biliar era de 2.4 milímetros de grosor, y el conducto biliar común tenía 4.2 milímetros de diámetro.
La bilirrubina era 2.5 Sin embargo las AST, ALT y GGT estaban dentro de la normalidad. Su amilasa era 17 y la lipasa 33. El recuento de leucocitos era 9.3 con un cambio hacia la izquierda de 90% de neutrófilos. Se discutieron las diferentes opciones con el paciente, y eligió la colecistectomía laparoscópica con una colangiografía intraoperatoria. Entendió los riesgos y beneficios de la operación y dio su consentimiento para grabar el procedimiento.
Se preparó al paciente para la la sala de operaciones con resucitación mediante el uso de fluidos IV y antibióticos.
Segment:2 Patient Positioning.
Se llevó al paciente al quirófano, preparado y cubierto de la manera habitual, bajo anestesia general con los brazos extendidos. Como cirujano, prefiero colocarme a la derecha del paciente, y que los residentes se sitúen a la izquierda.
Segment:3 Abdominal Cavity Exploration.
Se realiza una incisión vertical en la línea media del ombligo.
Se corta el tallo umbilical en circunferencia y el trocar romo se introduce en el anillo umbilical. La cavidad abdominal se infla con gas CO2 y se realiza la exploración. Se aprecia que la vesícula biliar está dilatada y algo inflamada. Había cambios inflamatorios crónicos en el cuadrante inferior izquierdo del colon sigmoideo. No se apreciaron más lesiones en la cavidad abdominal.
Segment:4 Trocar Placement and Surgery Begins.
Se colocaron tres puertos VersaStep de 5 milimetros en el cuadrante superior derecho bajo visón directa de la cámara. Es importante señalar que uso la mano izquierda para guiar la trayectoria del puerto al colocarlo en la cavidad abdominal. Una vez colocados los puertos, la vesícula biliar se levanta cefálicamente. Prefiero vaciar la vesícula de bilis, eso hace la disección más fácil.
Una vez que ya no hay bilis en la vesícula biliar, se liberan las adherencias mediante una disección de corte filo y tambien romo. Prefiero usar el disector de Kittner para liberar las adherencias. Las estructuras de la porta son cuidadosamente identificadas, incluidas la arteria hepática, el conducto biliar común, así como la arteria cística y su unión con el conducto biliar común.
Luego se disecciona el triángulo de Calot con el Kittner. Es importante replegar la vesícula biliar 90 grados hacia el conducto biliar común para asegurarse de que no hay lesión en el conducto biliar común. Se identifica el conducto biliar común en el cuadrante inferior derecho. Se ven el conducto cístico y la arteria cística.
Segment:5 Cholangiogram Performed.
Se realiza una colangiografía, haciendo una incisión en el conducto cístico en la unión con la vesícula biliar.
Se palpa entonces el conducto cístico usando el disector de Maryland para asegurarse de que no hay pequeñas piedras alojadas en el conducto cístico. Después se coloca el catéter de colangiografía en el conducto cístico y se grapa. Se pone al paciente sobre el lado derecho para asegurarse de que el conducto biliar común se separa de la espina. Se inyecta el contraste Hypaque al 50%. en el conducto biliar común.
Se puede ver que es normal en calibre. No hay presencia de piedras y hay un flujo de contraste libre en el duodeno.
Segment:6 Division of Cystic Duct and Artery.
Una vez que se retira el catéter se revisa entonces la anatomía y se colocan clips usando un aplicador de clips de 5 mm. Se corta el conducto cístico. Luego se disecciona cuidadosamente la arteria cística. Se colocan dos clips proximales y un clip distal y se corta la arteria cística.
Es importante diseccionar cuidadosamente la porta en este punto para la arteria cística posterior. Se ve como se recorta la arteria cística posterior. Se pone cuidado en buscar cualquier conducto de Luschka que pueda emanar del lecho hepático en la vesícula biliar.
Segment:7 Dissection of Gallbladder from Bed.
La espátula se engancha al irrigador de succión, que es una buena técnica que permite irrigar el lecho hepático y aspirar el humo.
Es importante prevenir que el humo salga de la cavidad abdominal hacia la habitación. Se presta mucha atención en permanecer en el plano entre la vesícula biliar y el lecho hepático para evitar lesiones en la vesícula biliar y en el lecho hepático. Se cauterizan los vasos. Una vez completada la disección, se coloca una cámara de 5mm en un puerto lateral, y se coloca una Endocatch en el puerto umbilical.
Se irriga el lecho hepático. Se logra la hemostasia. Se irriga el cuadrante superior derecho.
Segment:8 Closure.
Se retiran los trocares bajo visión directa de la cámara para asegurarse de que no hay sangre en los otros sitios de los trocares. Se cierra el sitio del trocar umbilical con tres o cuatro suturas interrumpidas de 0 Vicryl. Se cierra la piel con Monocryl 4-0. Las heridas se cubren con Steri-Strips y gasas estériles.
Se llevó al paciente a la sala de recuperación en condición excelente. Toleró bien el procedimiento, y fue dado de alta un día después de la operación.
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