Operative Note

PROCEDURE:      Laparoscopic cholecystectomy. 

SUMMARY:   The patient was brought to the operating room and after proper identification. With the patient awake, a Foley catheter was placed and the patient was intubated after the induction of appropriate anesthesia.  The patient remained under general anesthesia for the duration of the case. The patient was prepped with DuraPrep over the abdomen in the usual fashion and then he was draped in the usual sterile fashion. Following the draping, the pneumoperitoneum was established via direct access over the peritoneum via a supraumbilical incision. After direct visualization of the peritoneum, the trocar was introduced and insufflation was begun. 

After appropriate insufflation a 10 mm scope was inserted and the abdomen was visually inspected to be benign in gross visualization.  Next, another 11 mm port was placed in the right midepigastric region through the rectus abdominus muscle.  This was then followed by the placement of two 5 mm ports in the usual manner on the patient’s right hand side just below the costal margin.  The gallbladder was easily identified.  There were a few adhesions.  No intraabdominal fluid.  A generous amount of omental fat was present. Upon retraction of the gallbladder, the infundibulum was identified.  After some blunt dissection, the cystic duct was identified and then skeletonized using the small grasper.  After appropriate identification of the cystic duct, it was clipped 3 times with 2 clips staying, 1 clip going.  It was then transected with scissors.  This was performed without any complication. Next, a cystic artery was identified and 2 surgical clips on the proximal end and 1 surgical clip on the distal end were applied and this was transected using the laparoscopic scissors.  Following this, the gallbladder was easily retracted back and electrocautery was used to dissect the gallbladder fossa.  There was a well-established plane.  We came across one small arterial bleeder, approximately half way up the gallbladder fossa.  This was dealt with surgical clips.  After application of the clips, no further bleeding from this site was appreciated.  Hemostasis was attained on the gallbladder fossa using a small amount of electrocautery. Following the removal of the gallbladder from the gallbladder fossa, it was placed in an endobag and subsequently removed from the supraumbilical port site.  Next, the gallbladder was thoroughly irrigated with approximately 1 liter of normal saline and then sucked dry after returning the patient to the supine position.  The supraumbilical fascia was closed directly with 0 Vicryl and then the dermis was closed at all 4 incision sites with a 4-0 Monocryl absorbable monofilament in a running subcuticular manner. The fascia was closed in a simple interrupted manner.  Steri-Strips and dressings were placed over the incision sites. The patient was awakened from anesthesia.  The Foley catheter was removed prior to him being awakened from anesthesia. The patient was returned to post-anesthesia care unit in a stable condition.

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