Laparoscopic cholecystectomy or gall bladder surgery aims at treating symptomatic gall bladder stones. It is considered as the gold standard procedure for gall bladder removal. The choice is due to the several advantages of laparoscopic surgery, which includes reduced postoperative pain, early post operative recovery, early return to work, improved cosmesis and minimal intake of pain killer medicines.
There are several indications for gall bladder surgery:
Symptomatic Gall Stone Disease
Sonography (ultrasound scan) indicates the presence of identifiable gall bladder stones. Laparoscopic surgery is done for acute cholecystitis diagnosed within 72 hours of the onset of the symptoms. Beyond that period, open surgery may be required or the patient is treated with antibiotics and after recovery an interval gall bladder removal is done. Another indication of a laparoscopic procedure is recording an ejection fraction of < 35% at 20 minutes, if the patient has typical gall bladder related symptoms.
Silent gallstones are asymptomatic and can go on to become symptomatic. A diagnostic abdominal ultrasonography leads to the detection of unsuspected gall stones. In such a case, the patient needs to be under close follow up and gall bladder removal is done, if he or she develops symptoms.
Complex Gall Bladder Disease
Gallstone pancreatitis, incidental gallbladder cancer, acalculouscholecystitis, Mirizzi syndrome, cholecystoduodenal fistula, and choledocholithiasis are all complex gall bladder diseases which require a laparoscopic cholecystectomy.
A pneumoperitoneum is a necessity for a laparoscopic cholecystectomy
Patient is administered general anaesthesia
After placing the patient in a supine position, peripheral intravenous lines are inserted
Blood pressure monitors are placed along with pulse oximetry and electrocardiography
The procedure can be converted into an open, if any complicationsarise during the laparoscopic procedure, or if the anatomy is unclear and proceeding laparoscopically would cause damages to the nearby structures.
The conventional laparscopic cholecystectomy: In this approach, four small wounds are made in the abdomen, with the help of camera, telescope and delicate instruments, the gall bladder is dissected and removed through one of the wounds.
Minilaparoscopic cholecystectomy: As an aim to reduce invasiveness, this procedure is performed electively using 5 mm epigastric, 2 mm lateral, 2 mm subcostal and 10 mm umbilical ports.
Single-site cholecystectomy: A single port access or SPA is also known as single-port cholecystectomy or single-incision laparoscopic cholecystecomy (SILC) or even a single-incision laparoscopic surgery (SILS). A distinct and single entry point is made at the patient s umbilicus. In some cases, three discrete mini incisions are performed at a single site. This improves cosmesis considerably.
Dr. Deepak and his team of surgeons review each case and prepare a preliminary treatment plan best suited to the patient s disposition. The patient is also advised a post-operative course of treatment inclusive of monitoring and follow-up schedules before the operation itself.