Liver, Gallbladder, and Biliary Tree



Figs. 2.1 and 2.2
Equipment and patient position



A334519_1_En_2_Figa_HTML.gif



Surgical Steps



1.

Adhesion dissection

 

2.

Calot triangle opening

 

3.

Cystic duct and artery exposition and dissection

 

4.

Cholecystectomy

 

5.

Specimen extraction

 


Laparoscopic Instrument Table (Fig. 2.3a, b)





  • Sutures: 0 braided absorbable suture


  • Surgical scalpel blade No. 23


  • Gauzes


  • Stainless surgical bowl


  • Gross-Maier dressing forceps


  • Two Bernhard towel forceps


  • Veress needle and 10 mL syringe


  • One/two 10 mm trocars


  • Two/one 5 mm trocar


  • Two Farabeuf retractors


  • Two Backhaus forceps


  • Four Kocher forceps


  • Four Klemmer forceps


  • Needle holder


  • Foerster forceps


  • Kocher ribbed gorget


  • Two tissue forceps with teeth


  • Metzenbaum scissors


  • Mayo scissors


  • Randall-Mirizzi forceps for gallstones


  • Bipolar laparoscopic forceps


  • Crochet hook


  • Laparoscopic scissors


  • Two Johann forceps or graspers


  • 5–10 mm clip applier


  • Thermos


  • Endobag


A334519_1_En_2_Fig2_HTML.gif


Fig. 2.3
Instrument table


Instruments and Cables





  • 30, 5, or 10 mm laparoscope


  • Cold light source cable


  • CO2 pipe and filter


  • Monopolar electrocautery


  • Patient return electrode (REM)


  • Sterile instrument bag


  • Monopolar and bipolar electrocautery cables


  • Irrigation/suction laparoscopic device



2.2 Biliary Tree Surgery


The bed is placed in reverse Trendelenburg position with left tilt. First operator stands between patient’s legs (Fig. 2.4). Laparoscopic rack is placed behind patient’s head.

Specific surgical drapes are used.


Specific Instruments





  • Coledocoscope


  • Fluoroscopic C-arm machine


  • Laparoscopic ultrasonography


Laparoscopic Instrument Table





  • Sutures: 0 braided absorbable suture and 5-0 slowly absorbable monofilament suture


  • Surgical scalpel blade No. 23


  • Gauzes


  • Stainless surgical bowl


  • Gross-Maier dressing forceps


  • Two Bernhard towel forceps


  • Veress needle and 10 mL syringe


  • One/two 10 mm trocars


  • Two/one 5 mm trocar


  • Two Farabeuf retractors


  • Two Backhaus forceps


  • Two Kocher forceps


  • Four Klemmer forceps


  • Needle holder


  • Foerster forceps


  • Kocher ribbed gorget


  • Three tissue forceps with teeth


  • Metzenbaum scissors


  • Mayo scissors


  • Randall-Mirizzi forceps for gallstones


  • Bipolar laparoscopic forceps


  • Crochet hook


  • Laparoscopic scissors


  • Two Johann forceps or graspers


  • 5–10 mm clip applier


  • Kehr probe


  • Intraoperative cholangiography kit and contrast agent


  • Dormia laparoscopic probe


  • Fogarty catheters (various diameters)


  • Thermos


  • Endobag

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Jun 5, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Liver, Gallbladder, and Biliary Tree

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