TECHNICUE OF LAP. CHOLE

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TECHNICUE OF LAP. CHOLE

• BY. DR . AHMED KENSARAH

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Technique of lap chole

• Grasping forceps are pushing up the fundus of the
  gallbladder elevating the liver and stretching
  the gallbladder longitudinally
• Asecond instrument holds the hartmanns pouch
  allowing a good visualization of triangle of
  calot.

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Technique of lap chole

• This image shows a lateral retraction on the
  Hartmnns pouch, pulling the cystic duct and
  artery away from hepatic duct.
• A disector is passed through to isolate the
  cystic duct from the artery.

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Technique of lap chole

• Once the cystic artery is isolated and cleaned
  its attachments, the cystic duct is dissected
  and clearly visualized by pushing backwards the
  cystic artery and forward the duct in one single
  manouver.

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Technique of lap chle

• Upon completition of thedissection , clips are
  applied to the cystic artery and divided with
  scissors.

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Technique of lap chole

• Now the cystic duct is doubly clipped and then
  transected with scissors.
• Electrocautery or laser should not be used to
  avoid necrosis of tissue under the clips and
  possible post-operative bile leakage.

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Technique of lap chole

• Dissection is performladdered through each side
  of the gallbldder dividing the peritoneal
  reflection.
• The Hartmanns pouch is pulled superiorly and
  medially to permit good field exposure while the
  gallbladder is being freed from the liver bed it
  can be removed .

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