monthly focus

operative technique

Cholecystectomy, consisting of complete removal of the gallbladder, was one of the first surgical interventions to be performed laparoscopically.

Laparoscopic cholecystectomy is performed using the same operative technique and principles as open cholecystectomy. Nonetheless, the two-dimensional downward to upward view coupled with the use of long instruments for distance manipulation requires specific training. Furthermore, the laparoscopic approach is associated with a risk of specific complications during the learning curve. One should always bear in mind that there is no such thing as a simple cholecystectomy.

Cholecystectomy, consisting of complete removal of the gallbladder, was one of the first surgical interventions to be performed laparoscopically.
Laparoscopic cholecystectomy is performed using the same operative technique and principles as open cholecystectomy. Nonetheless, the two-dimensional downward to upward view coupled with the use of long instruments for distance manipulation requires specific training. Furthermore, the laparoscopic approach is associated with a risk of specific complications during the learning curve. One should always bear in mind that there is no such thing as a simple cholecystectomy.

Laparoscopic cholecystectomy for symptomatic cholelithiasis with or without cholangiogram

La cholécystectomie, qui consiste en l'ablation complète de la vésicule biliaire, a été l'une des premières interventions chirurgicales réalisées par laparoscopie.

La cholécystectomie laparoscopique est réalisée selon la même technique et les mêmes principes opératoires que la cholécystectomie par chirurgie ouverte. Néanmoins, la vue bidimensionnelle de bas en haut associée à l'utilisation d'instruments longs pour la manipulation à distance nécessite une formation spécifique. En outre, l'approche laparoscopique est associée à un risque de complications spécifiques pendant la courbe d'apprentissage. Il faut toujours garder à l'esprit qu'il n'existe pas de cholécystectomie simple.

Cholécystectomie laparoscopique pour cholélithiase symptomatique avec ou sans cholangiographie peropératoire

video lecture

Лапароскопическая холецистэктомия по поводу холецистита

Laparoscopic cholecystectomy for cholecystitis

Cholécystectomie laparoscopique pour cholécystite

surgical intervention video

In this key lecture presented during the IRCAD online course on laparoscopic cholecystectomy, Dr. Michele Diana is providing an outline on the use of near-infrared fluorescence imaging (NIRF) cholangiography during laparoscopic cholecystectomy procedures. Additionally, the role of NIRF cholangiography, multimodal intraoperative imaging, and other imaging technologies are described with an emphasis on the key published studies on these topics. 

Imaging during laparoscopic cholecystectomy

L'imagerie lors d'une cholécystectomie laparoscopique

Mirizzi syndrome is often not recognized preoperatively in patients undergoing cholecystectomy and can lead to significant morbidity and biliary injury, particularly with laparoscopic surgery. This video demonstrates the laparoscopic management of a type I Mirizzi syndrome according to the Csendes classification using a subtotal cholecystectomy, which is also called a bailout procedure. In addition, we intended to present the impact of the endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic nasobiliary drainage (ENBD) tube for the management of biliary tract difficulties. ERCP was performed right before the operation in order to achieve adequate preoperative evaluation and to place a nasobiliary tube. In this case, this tube provides several advantages, i.e. decompression, landmark to identify common hepatic duct, and access for cholangiography. 

Laparoscopic management of a type I Mirizzi syndrome: subtotal cholecystectomy

Prise en charge laparoscopique d'un syndrome de Mirizzi de type I : cholécystectomie sous-totale

webinar

Relive the highlights of the last IRCAD online course dedicated to the Critical View of Safety (CVS) in laparoscopic cholecystectomy, which took place at IRCAD France last January 8, 2021.

IRCAD online course - Critical View of Safety (CVS) in laparoscopic cholecystectomy

online course package

Cours IRCAD en ligne  - cholécystectomie laparoscopique et vision critique de la sécurité

Relive the highlights of the IRCAD online Course dedicated to the Critical View of Safety (CVS) in laparoscopic cholecystectomy, which took place at IRCAD France last January 8, 2021. 

Authors report the case of a 55-year-old male patient who was operated on for a perforated ulcer 13 years earlier. He had undergone a truncal bilateral vagotomy combined with a Judd pyloroplasty. He was admitted to the emergency department for an acute lithiasic cholecystitis. A laparoscopic surgery was decided upon. The patient had a cholecystectomy using three trocars. The postoperative period was uneventful. 

Difficult cholecystectomy on a scarred abdomen for acute cholecystitis

Cholécystectomie difficile sur un abdomen cicatriciel pour cholécystite aiguë

This video demonstrates a laparoscopic cholecystectomy pinpointing the Rouviere sulcus as a landmark for adequate dissection of the hepatocystic (Calot's) triangle, without commentary. Enjoy this new video format of self-explanatory surgery and let the pictures do the talking.

Let the pictures do the talking - Laparoscopic cholecystectomy: the Rouviere sulcus as a landmark for adequate dissection of hepatocystic (Calot's) triangle

Laissez parler les images - Cholécystectomie laparoscopique : le sillon de Rouvière, un repère anatomique pour dissection adéquate du triangle hépatocystique (triangle de Calot)

This video demonstrates a laparoscopic cholecystectomy, highlighting a vascular anatomical variation (i.e., an accessory right hepatic artery), without commentary. Enjoy this new video format of self-explanatory surgery and let the pictures do the talking.

Bibliography: 

Polguj M, Podgórski M, Hogendorf P, Topol M. Variations of the hepatobiliary vasculature including coexistence of accessory right hepatic artery with unusually arising double cystic arteries: case report and literature review. Anat Sci Int. 2014 Jun;89(3):195-8. doi: 10.1007/s12565-013-0219-5. Epub 2013 Dec 6. PMID: 24310410; PMCID: PMC4015057.

Favelier S, Germain T, Genson PY, Cercueil JP, Denys A, Krausé D, Guiu B. Anatomy of liver arteries for interventional radiology. Diagn Interv Imaging. 2015 Jun;96(6):537-46. doi: 10.1016/j.diii.2013.12.001. Epub 2014 Feb 16. PMID: 24534562.

Let the pictures do the talking - Laparoscopic cholecystectomy: vascular anatomical variation (accessory right hepatic artery)

Laissez parler les images - Cholécystectomie laparoscopique : variation anatomique vasculaire (artère hépatique droite accessoire)

This video demonstrates a laparoscopic cholecystectomy, highlighting a vascular anatomical variation (i.e., an accessory right hepatic artery), without commentary. Enjoy this new video format of self-explanatory surgery and let the pictures do the talking.

Bibliography: Andall RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. 2016 Jul;38(5):529-39. doi: 10.1007/s00276-015-1600-y. Epub 2015 Dec 23. PMID: 26698600.

Focus on laparoscopic cholecystectomy

Laparoscopic management of a type I Mirizzi syndrome: subtotal cholecystectomy

Difficult cholecystectomy on a scarred abdomen for acute cholecystitis

Imaging during laparoscopic cholecystectomy

Laparoscopic cholecystectomy for symptomatic cholelithiasis with or without cholangiogram

IRCAD online course - Critical View of Safety (CVS) in laparoscopic cholecystectomy

Laparoscopic cholecystectomy for cholecystitis

Let the pictures do the talking - Laparoscopic cholecystectomy: the Rouviere sulcus as a landmark for adequate dissection of hepatocystic (Calot's) triangle

Let the pictures do the talking - Laparoscopic cholecystectomy: vascular anatomical variation (accessory right hepatic artery)

Let the pictures do the talking - Laparoscopic cholecystectomy: vascular anatomical variation (accessory right hepatic artery)