What is the technique for mobilization and laparoscopic removal of the gallbladder?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Once the cystic structures have been clipped and divided, the infundibulum is retracted cephalad. A hook or spatula is used to develop a plane in the areolar tissue between gallbladder and liver with smooth sweeping movements from right to left and back again. As in any surgical procedure, the traction-countertraction rule is essential. As the dissection marches up the gallbladder bed, the assistant should reposition his or her graspers to ensure optimal tension on the areolar tissue between gallbladder and liver bed (see the images below).

Laparoscopic cholecystectomy. Use of hook to devel Laparoscopic cholecystectomy. Use of hook to develop plane in areolar tissue between gallbladder and liver.
Laparoscopic cholecystectomy. Use of traction and Laparoscopic cholecystectomy. Use of traction and hook to remove gallbladder from gallbladder bed.
Laparoscopic cholecystectomy. Side-to-side sweepin Laparoscopic cholecystectomy. Side-to-side sweeping motion with electrocautery to remove gallbladder from gallbladder bed.

It is important to be alert for any aberrant vessels and ducts that may arise from the liver bed and enter directly into the gallbladder. These should be clipped and not simply cauterized.

Before the last strands connecting the gallbladder to the liver are divided, a final inspection of the gallbladder fossa and the clipped cystic structures should be carried out. Any bleeding points in the gallbladder fossa should be controlled at this time, before the gallbladder is completely separated from the liver (see the image below). This is the surgeon’s last opportunity to visualize these areas well.

Laparoscopic cholecystectomy. Cauterization of any Laparoscopic cholecystectomy. Cauterization of any bleeding in gallbladder bed before complete division of gallbladder.

Both 5-mm graspers are applied to the gallbladder and used to hold it over the right upper quadrant. The laparoscope is transferred to the subxiphoid port, and an endoscopic retrieval pouch is inserted through the umbilical trocar. The gallbladder is placed in the bag, which is then cinched closed. (See the images below.) The authors prefer to leave the bag suspended from the umbilical trocar while they replace the camera through the same port and perform the final inspection and washout.

Laparoscopic cholecystectomy. Placement of gallbla Laparoscopic cholecystectomy. Placement of gallbladder into endoscopic retrieval pouch.
Laparoscopic cholecystectomy. Placement of gallbla Laparoscopic cholecystectomy. Placement of gallbladder into endoscopic retrieval pouch and removal of instrument from pouch.

The table is returned to the neutral position. The gallbladder bed and the suprahepatic spaces are irrigated and suctioned to ensure adequate hemostasis and removal of any debris or bile that may have spilled (see the image below).

Laparoscopic cholecystectomy. Irrigation and sucti Laparoscopic cholecystectomy. Irrigation and suction of gallbladder bed.

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