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LIVE UNCUT SURGERY: laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy.
The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected.
After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe.
Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia.
This 20-minute live uncut video is a demonstration of a gold standard procedure.
D Mutter, G Philouze, B Seeliger, J Marescaux
Surgical intervention
10 months ago
16817 views
120 likes
12 comments
30:23
LIVE UNCUT SURGERY: laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy.
The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected.
After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe.
Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia.
This 20-minute live uncut video is a demonstration of a gold standard procedure.
Laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy. The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected. After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe. Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia. This 20-minute live uncut video is a demonstration of a gold standard procedure.
D Mutter, G Philouze, B Seeliger, J Marescaux
How to
10 months ago
16810 views
120 likes
0 comments
00:30:23
Laparoscopic cholecystectomy for cholelithiasis, a gold standard procedure
This video describes an "ideal" cholecystectomy, with a stepwise approach to the cystic pedicle and the dissection of the gallbladder. This video emphasizes the key points of dissection necessary to perform a safe cholecystectomy. The initial approach aims to expose the infundibulum and to successively dissect the anterior and posterior reflection of the peritoneum. It provides a safe view of the cystic duct and the cystic artery which can be dissected in order to secure the “critical view of safety”, exposing the cystic artery clearly away from the common bile duct and the right hepatic artery. This highlights the risky parts of the dissection when rules are not respected. After complete control of the pedicle, freeing of the gallbladder in the appropriate plane avoids any oozing, keeping the operative field totally clear and safe. Finally, the video shows the extraction method for the gallbladder, allowing the procedure to be performed with three 5mm ports and one 10-12mm port, thereby limiting the risk of postoperative port-site hernia. This 20-minute live uncut video is a demonstration of a gold standard procedure.
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Gf Donatelli, F Cereatti, B Meduri
Surgical intervention
4 years ago
1492 views
62 likes
0 comments
03:26
Diagnosis and treatment of symptomatic common bile duct stones following cholecystectomy by means of EUS and ERCP
A post-cholecystectomy syndrome is a well-known condition, which includes dyspepsia and biliary-like abdominal pain coupled with deterioration of liver enzymes. Biliary factors responsible for a post-cholecystectomy syndrome could be the following: biliary iatrogenic duct strictures, retained stones in the common bile duct (CBD), cystic stump, or even a gallbladder remnant.
The diagnosis of stones is difficult to establish considering that even trans-abdominal ultrasonography has a diagnostic sensitivity of only 27%. Conversely, endoscopic ultrasound (EUS) is a very useful tool to diagnose stones in such situations, allowing to perform subsequent ERCP and stone extraction during the same anesthetic session. Here, we report the case of a 69-year-old man who underwent laparoscopic cholecystectomy and who was referred to us after 24 hours of abdominal colic pain and cholestasis. He underwent EUS, which diagnosed residual common bile duct stones. As a result, treatment was performed by means of ERCP during the same session.
Single port cholecystectomy: impact of instrumentation in getting the critical view of safety
Single port access surgery may be the next generation of minimally invasive surgery thanks to the obvious advantages (e.g., scarless surgery, lesser pain, and faster postoperative recovery). Performing a cholecystectomy via a single trocar imposes a few technical constraints. The first is the necessity of correctly exposing the gallbladder, the second is to find the instrumentation that allows to perform the different dissection stages, ligature of the cystic duct and artery, but also to obtain an acceptable visualization of the Calot’s triangle. Various methods are proposed at the moment, along with different instruments: rigid, articulated, curved ones. In this video, we present two cholecystectomies, one is performed with conventional laparoscopic instruments, the other with curved instruments especially adapted for a unique trocar.
B Dallemagne, J Leroy, J Marescaux
Surgical intervention
9 years ago
1066 views
43 likes
0 comments
07:41
Single port cholecystectomy: impact of instrumentation in getting the critical view of safety
Single port access surgery may be the next generation of minimally invasive surgery thanks to the obvious advantages (e.g., scarless surgery, lesser pain, and faster postoperative recovery). Performing a cholecystectomy via a single trocar imposes a few technical constraints. The first is the necessity of correctly exposing the gallbladder, the second is to find the instrumentation that allows to perform the different dissection stages, ligature of the cystic duct and artery, but also to obtain an acceptable visualization of the Calot’s triangle. Various methods are proposed at the moment, along with different instruments: rigid, articulated, curved ones. In this video, we present two cholecystectomies, one is performed with conventional laparoscopic instruments, the other with curved instruments especially adapted for a unique trocar.
Dealing with vascular variation: laparoscopic cholecystectomy
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.
D Mutter, J Marescaux, C Solano
Surgical intervention
11 years ago
3394 views
128 likes
0 comments
09:14
Dealing with vascular variation: laparoscopic cholecystectomy
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.
Micro-instrumentation for minimally invasive cholecystectomy: surgical technique
This video demonstrates an esthetic cholecystectomy using 2mm micro-instruments. The key steps and difficulties of this procedure are shown in detail by Professor Didier Mutter. This video is recommended to general surgeons.
The authors use 2mm micro-instruments in this 25-year-old woman with symptomatic cholelithiasis. They dissect in the avascular plane between Glisson’s capsule and the gallbladder. Dissection with the micro-instruments is more time-consuming than with conventional instruments because the 2mm instruments have two drawbacks: flexibility, and being situated inside the abdomen with little of the instrument on the outside. After the dissection, the authors remove the 2 cameras and introduce the extraction bag through the umbilicus. They then reinsert the 10mm camera to check the operative field and help guide removal of the trocars. This step helps to minimize postoperative hemorrhage. Cosmesis is enhanced with three 2mm incisions and one 10mm incision deep in the umbilicus.
D Mutter, J Marescaux
Surgical intervention
12 years ago
115 views
13 likes
0 comments
05:41
Micro-instrumentation for minimally invasive cholecystectomy: surgical technique
This video demonstrates an esthetic cholecystectomy using 2mm micro-instruments. The key steps and difficulties of this procedure are shown in detail by Professor Didier Mutter. This video is recommended to general surgeons.
The authors use 2mm micro-instruments in this 25-year-old woman with symptomatic cholelithiasis. They dissect in the avascular plane between Glisson’s capsule and the gallbladder. Dissection with the micro-instruments is more time-consuming than with conventional instruments because the 2mm instruments have two drawbacks: flexibility, and being situated inside the abdomen with little of the instrument on the outside. After the dissection, the authors remove the 2 cameras and introduce the extraction bag through the umbilicus. They then reinsert the 10mm camera to check the operative field and help guide removal of the trocars. This step helps to minimize postoperative hemorrhage. Cosmesis is enhanced with three 2mm incisions and one 10mm incision deep in the umbilicus.