Dealing with vascular variation: laparoscopic cholecystectomy
Epublication WebSurg.com, Jan 2008;08(01). URL: http://websurg.com/doi/vd01en2242
This video describes the technique of laparoscopic cholecystectomy for symptomatic cholelithiasis with intraoperative cholangiography. The key steps are presented: exploration, exposure, dissection of Calot’s triangle, intraoperative cholangiography, clipping and division, gallbladder bed dissection. This technique is well standardized for the management of this condition. The authors use intraoperative cholangiography for symptomatic cholelithiasis. To dissect Calot’s triangle, the authors first place grasping forceps through the epigastric trocar to grasp the gallbladder’s fundus and retract it cephalad and toward the patient’s right shoulder. They use a second grasping forceps on the infundibulum and retract the gallbladder laterally and caudally, thus opening Calot’s triangle. They start the dissection close at the junction of the infundibulum with the cystic duct, then incise the anterior and posterior peritoneal leaflets to access the vascular and biliary elements of Calot’s triangle. They then skeletonize the cystic duct and cystic artery.