腹腔镜胆囊切除术的艺术 - 胆囊癌

The art of laparoscopic cholecystectomy - gallbladder cancer

发布时间：2013-06-26

Dissection of the gallbladder and operative cholangiogram for suspicion of malignancy located in the gallbladder fundus: no touch technique -- the gallbladder is not manipulated or dissected until the vascular supply and drainage is disconnected and the cystic duct is clipped and divided. The omental adhesions around the gallbladder fundus are removed en-bloc; the liver is retracted with a Nathanson's liver retractor without touching the gallbladder; the peritoneum is incised over the hepatic artery and the CBD and hepatic duct are skeletonised to the confluence of the left and right hepatic ducts; the right hepatic artery is also displayed; the soft tissue from the duodenum to the confluence of the duct is removed en-bloc with the gallbladder; a short cystic duct is demonstrated, clipped and divided; the gallbladder is dissected and placed into an endobag -- a fine duct of Luschka draining the gallbladder fundus is demonstrated; operative cholangiogram with demonstration of the anatomy of the biliary tree is performed and the very short cystic duct stump is suture-ligated with 3/0 PDS flush to the common bile duct; no bleeding, no bile spillage, no tumour manipulation.