Laparoscopic Cholecystectomy: Step-by-step

This is one of the most commonly performed procedures in the western world. It is often done as a day case procedure and when correctly performed is associated with little post-operative pain or morbidity. The following steps are generally taken:

1) General anaesthesia

2) Creation of pneumoperitoneum: 1cm subumbilical (or transumbilical) incision. Dissection to peritoneum and insertion of trocar. Insufflation using CO2 and insertion of camera.

3) The patient is placed with their head down and tilted to the left position.

4) Placement of at least two other ports. A grasper is inserted at the top of the gallbladder and locked into place. The camera assistant then uses the other hand to apply upwards traction on the gallbladder in order to maximise the surgeon’s access to Calot’s triangle.

5) The surgeon then either uses one or two ports to dissect around Calot’s triangle using a grasper, Pledget and hook diathermy.

6) Clips are then placed around the cystic artery and duct – two below and one above where they will be cut.

7) Scissors are then used to cut the duct and artery.

8) The gall bladder is then dissected off the liver and a bag is used to remove it out of the abdomen.

9) The surgeon then looks around for any bleeding or bile leak and performs washout if necessary.

10) The ports are opened and gas stopped to remove free gas.

11) The peritoneum is closed at the umbilicus then the subcutaneous tissue and skin are closed.

12)  The rest of the ports are closed at the skin only.

13) Dressings are placed and the patient woken up.



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