Upper GI

Cholecystectomy (Laparoscopic) (Variant)

OPERATION: Cholecystectomy (Laparoscopic)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: As per local policy
POSITION: Supine, left arm tucked. Steep reverse Trendelenburg with right side tilted up for dissection. Orogastric tube inserted.

INDICATION:
[Symptomatic cholelithiasis / acute cholecystitis / gallstone pancreatitis / biliary colic / gallbladder polyp]. Preoperative imaging: USS [findings].

PROCEDURE:
WHO Checklist performed. Abdomen prepared and draped.

PORT PLACEMENT:
Umbilical or supraumbilical access via Veress needle. Pneumoperitoneum to 12-15 mmHg. 10/11 mm optical access port at umbilicus. 30 degree laparoscope introduced. Epigastric 10/11 mm port placed under direct vision based on the liver edge. Two 5 mm ports placed along the right costal margin: one at the midclavicular line, one at the anterior axillary line. Patient placed in steep reverse Trendelenburg with right side up.

DISSECTION AND CRITICAL VIEW OF SAFETY:
Fundus of gallbladder grasped via the lateral-most port and retracted superiorly over the liver edge. Infundibulum grasped via the midclavicular port and retracted laterally to open the hepatocystic triangle. Peritoneal coverings over the anterior and posterior aspects of the hepatocystic triangle taken down using blunt dissection and short bursts of diathermy. Node of Calot identified and separated from the gallbladder. Fatty tissue cleared from the infundibulum, cystic duct, and cystic artery.

Critical View of Safety (CVS) achieved: only two structures seen entering the gallbladder — the cystic duct and cystic artery — with the lower portion of the cystic plate clearly visible.

[Intraoperative cholangiogram performed: findings — normal biliary anatomy confirmed / common bile duct stone identified and managed.]

CLIPPING AND DIVISION:
Two clips applied to the cystic duct proximally (towards gallbladder) and two clips distally (towards CBD). Cystic duct divided between clip groups. Cystic artery clipped x2 and divided.

GALLBLADDER REMOVAL:
Gallbladder dissected from the liver bed using hook diathermy in the avascular plane, working from the infundibulum towards the fundus. Final observation of liver bed and cystic structures to confirm haemostasis before full detachment. Gallbladder retrieved via endoscopic retrieval bag through the umbilical port. [Port site extended for extraction of large-stone or acutely inflamed gallbladder.]

CLOSURE:
Pneumoperitoneum reduced. Final inspection confirms haemostasis and no bile leak. All ports removed under direct vision. Fascia of 10/11 mm port closed. Skin closed with subcuticular absorbable suture.

FINDINGS:
[Chronically / acutely inflamed] gallbladder. Contents: [calculi / mucocele / empyema / sludge]. Biliary anatomy [normal / variant — describe]. Liver bed [clean / haemostasis achieved with diathermy].

SPECIMEN: Gallbladder to histopathology.
EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Eat and drink as tolerated. Discharge when comfortable. Outpatient review with histology if incidental pathology suspected.