Amongst laparoscopic operations cholecystectomy is the classical procedure that started it all. Today the technique has been improved over and over and in competent hands more than 95% of all cholecystectomies can be completed laparoscopically. Only in very rare cases with maximum putrid inflammation of the gallbladder or in patients with severe abdominal adhesions following previous operations the old conventional open procedure is used. Of course we always organize our laparoscopic operations under full standby for an open procedure in case of an emergency. This enables us to convert to the open operation within a few seconds if necessary.
see figure 1 see figure 2 see figure 3
For the laparoscopic procedure 4 small ports (metal tubes) are inserted through small incisions in the abdominal wall. They serve as access for the camera and the surgical instruments. The abdomen is inflated with sterile CO2 to enable visualization of the organs.
The connection between main bile duct and the gallbladder as well as the artery to the gallbladder are closed with tiny clips and then divided. The gallbladder is now dissected out of its bed in the liver and removed with the stones through the incision at the umbilicus. This procedure takes 25-30 minutes and hospital stay is 2-3 days. I refuse to discharge my patients faster, because I want to be sure everything is fine when they leave the hospital. Accordingly my readmission rate is very close to 0%.
The main advantage of this operation is the short recovery time, the lack of postoperative pain and the very convincing cosmetic result combined with an extremely low complication rate. Procedures like dissolving or removing only the stones or destruction of the stones by shock waves with preservation of the gallbladder have high complication rates and the stones will return unless a lifelong medication is started after the procedure. Other procedures like ”single port cholecystectomy” or “notes” have very few advantages, are quite dangerous in my opinion and are not suited for routine use. I do not recommend any of these techniques.
