Cirurgia de Vesícula Sem Clipes - 105kg - FullHd GoPro - 08/2017

Introduction

This tutorial outlines the step-by-step process of performing a laparoscopic gallbladder surgery without clips, as demonstrated in a video featuring a patient with recurrent gallbladder pain. This guide is intended for medical professionals and students interested in surgical techniques, specifically cholecystectomy procedures.

Step 1: Patient Preparation

• Ensure the patient is informed and consents to the procedure.
• Assess the patient's medical history, focusing on episodes of gallbladder pain, especially after fatty meals.
• Perform necessary preoperative evaluations, including imaging studies to check for gallstones.

Step 2: Surgical Setup

• Position the patient on the operating table in a supine position.
• Use general anesthesia to ensure the patient is unconscious and pain-free.
• Prepare and sterilize the surgical field.

Step 3: Initial Access and Trocar Placement

• Make a small incision at the umbilicus to insert the first trocar.
• Introduce carbon dioxide gas to create a pneumoperitoneum, which helps to expand the abdominal cavity for better visibility.
• Place additional trocars in the right upper quadrant for instrument access.

Step 4: Dissection of the Gallbladder

• Begin with retrograde dissection, moving from the fundus and body of the gallbladder.
• Carefully dissect the gallbladder from surrounding tissues using appropriate instruments.

Step 5: Identification and Isolation of Structures

• Identify the cystic duct and cystic artery.
• Use blunt dissection to isolate these structures carefully, ensuring no injury occurs.
• If necessary, utilize electrosurgical tools for cauterization.

Step 6: Cauterization of the Cystic Artery

• Cauterize the cystic artery using a monopolar hook and grasping forceps.
• Set the electrosurgical unit to 40 watts for cutting and 30 watts for coagulation, using the blend mode primarily for coagulation.

Step 7: Clipping and Cutting the Cystic Duct

• Use vicryl 0 sutures for intracorporeal ligation of the cystic duct.
• Cut the cystic duct after securing it with sutures to prevent bile leakage.

Step 8: Extraction of the Gallbladder

• Place the gallbladder in a retrieval bag or glove to facilitate removal.
• Gently extract the gallbladder from the abdominal cavity, ensuring that any stones are also removed.

Step 9: Closure of Incisions

• Approximate the umbilical aponeurosis with X sutures using Prolene 0.
• Suture the skin using nylon 4.0 for a secure closure and to minimize scarring.

Conclusion

This tutorial provides a comprehensive overview of performing a laparoscopic cholecystectomy without clips, highlighting crucial steps from patient preparation to postoperative care. Following these steps can lead to successful surgical outcomes, as evidenced by the patient’s favorable recovery and discharge the day after surgery. For further learning, consider reviewing additional surgical techniques and complications associated with gallbladder surgery.