Robotic-assisted laparoscopic cholecystectomy
PREOPERATIVE DIAGNOSIS
Biliary dyskinesia.
POSTOPERATIVE DIAGNOSIS
Biliary dyskinesia.
PROCEDURE
Robotic-assisted laparoscopic cholecystectomy.
ANESTHESIA
General.
ESTIMATED BLOOD LOSS
Minimal.
COMPLICATIONS
None.
SPECIMEN
Gallbladder.
DISPOSITION
To PACU in stable condition.
DESCRIPTION OF PROCEDURE
This patient was brought to the operative suite, placed supine on the operating table. After adequate general anesthesia had been achieved, the abdomen was prepped and draped in the usual sterile fashion. Then, using a #15 blade, an infraumbilical curvilinear incision was made. The incision was extended down to underlying subcutaneous tissue and cautery was used for hemostasis. A Veress needle was inserted and the abdomen was then insufflated with CO2 to create a pneumoperitoneum. Then, a bladeless trocar was inserted in the abdomen and the laparoscope was inserted. The abdomen was examined and there was no evidence of any bowel injuries or injury to any abdominal viscera. Then, three additional 8-mm robotic trocars were inserted into the abdomen under direct visualization, two in the left upper quadrant and one in the right lower quadrant. After this was completed, the robot was then docked to the patient. The patient was placed in the reverse Trendelenburg position. Then, the gallbladder was visualized and there were noted to be some inflammatory adhesions around the gallbladder, which were easily taken down using cautery. Then, the gallbladder was retracted cephalad. The cystic duct and cystic artery were then both dissected out of the triangle of Calot, clipped and divided. The gallbladder was then dissected off the gallbladder fossa using the cautery and once completed, the gallbladder was then placed in an Endopouch and removed through the umbilical port. The pneumoperitoneum was released and the robot was undocked from the patient. The fascia at the umbilicus was closed with 0 Vicryl suture in an interrupted figure-of-eight fashion and the skin incisions were then closed with 4-0 Vicryl in a subcuticular fashion. Dermabond dressings were applied. Needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well and was then transferred to the PACU in stable condition.
Biliary dyskinesia.
POSTOPERATIVE DIAGNOSIS
Biliary dyskinesia.
PROCEDURE
Robotic-assisted laparoscopic cholecystectomy.
ANESTHESIA
General.
ESTIMATED BLOOD LOSS
Minimal.
COMPLICATIONS
None.
SPECIMEN
Gallbladder.
DISPOSITION
To PACU in stable condition.
DESCRIPTION OF PROCEDURE
This patient was brought to the operative suite, placed supine on the operating table. After adequate general anesthesia had been achieved, the abdomen was prepped and draped in the usual sterile fashion. Then, using a #15 blade, an infraumbilical curvilinear incision was made. The incision was extended down to underlying subcutaneous tissue and cautery was used for hemostasis. A Veress needle was inserted and the abdomen was then insufflated with CO2 to create a pneumoperitoneum. Then, a bladeless trocar was inserted in the abdomen and the laparoscope was inserted. The abdomen was examined and there was no evidence of any bowel injuries or injury to any abdominal viscera. Then, three additional 8-mm robotic trocars were inserted into the abdomen under direct visualization, two in the left upper quadrant and one in the right lower quadrant. After this was completed, the robot was then docked to the patient. The patient was placed in the reverse Trendelenburg position. Then, the gallbladder was visualized and there were noted to be some inflammatory adhesions around the gallbladder, which were easily taken down using cautery. Then, the gallbladder was retracted cephalad. The cystic duct and cystic artery were then both dissected out of the triangle of Calot, clipped and divided. The gallbladder was then dissected off the gallbladder fossa using the cautery and once completed, the gallbladder was then placed in an Endopouch and removed through the umbilical port. The pneumoperitoneum was released and the robot was undocked from the patient. The fascia at the umbilicus was closed with 0 Vicryl suture in an interrupted figure-of-eight fashion and the skin incisions were then closed with 4-0 Vicryl in a subcuticular fashion. Dermabond dressings were applied. Needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well and was then transferred to the PACU in stable condition.
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