Cholecystectomy for Mucocele of Gallbladder

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This video demonstrates Laparoscopic Cholecystectomy for Mucocele of the Gallbladder. A mucocele of the gallbladder must be differentiated from other gallbladder conditions. Acute percutaneous drainage vs. cholecystectomy is usually the first line of treatment. This diagnosis must be suspected both by the surgeon and the radiologist. Gallbladder mucoceles (GBM) typically are treated by cholecystectomy. Medical management rarely has been reported and medical and surgical management have not been compared.  In Laparoscopic management of the Mucocele of the Gallbladder, a small incision is made just below the rib cage on the right side of the abdomen. The liver is moved to expose the gallbladder. The vessels and cystic duct and artery to and from the gallbladder are cut and the gallbladder is removed. Mishra's knot is used to ligate the cystic duct.  For more please contact:  World Laparoscopy Hospital Cyber City, Gurugram, NCR Delhi INDIA Phone: +919811416838

Transcript

00:00hello friends this is a case of laparoscopic cholecystectomy for mucosheal of the gall

00:07bladder and we will use here the misra's knot to ligate the cystic duct so this is the gall

00:15bladder and by the fourth port it is retracted towards the right shoulder in the mucosheal

00:23it is better to aspirate it first so we are using here aspiration needle and aspirating

00:29the mucus we can see in this syringe the clear mucus fluid is coming and after that the third

00:41port will give anterolateral and anteromedial traction so the first step is we should remove

00:49all the adhesions here we are using harmonic scalpel for this surgery and these are just

00:56the flimsy adhesions which is removed by giving the traction and this is a stripping technique

01:03you can strip all those adhesions after that this is the posterior peritoneum so horseman

01:09pouch should give anteromedial traction and you can open the posterior peritoneum of the

01:15gall bedded at the level of the body of the gall bedded we are always above the roviate

01:22sulcus and this is separation of the posterior peritoneum the teflon jaw of harmonic should

01:28be kept towards the gall bedded so that gall bedded should not puncture and left hand should

01:34give anteromedial traction after that this is anterolateral traction and the same peritoneal

01:43dissection should be done anteriorly and it should be opened at the level of the body of the gall

01:48better only peritoneum should be separated so that you can make a posterior window carefully

02:04now these are the peritoneum over the cystic peritical which is stripped and skeletonized

02:11cystic peritical should be skeletonized by stripping down

02:15and only peritoneum should be dissected

02:22after that the job of the harmonic or hook hook also you can use

02:28job of harmonic and hook is over then we can bring a maryland and we can dissect to make the

02:36critical view of safety and anterior and posterior peritoneum

02:39so this is the separation of the posterior window

02:47and this is in between the artery and the inferior surface of liver

02:53now here we have the anterior window which is in between the duct and the artery

03:00so now little stripping of the and skeletonizing of the cystic duct

03:11we can see this is the posterior window and anterior window and artery and duct

03:15two structure so going towards the gall barrier

03:18this is icg mode you can clear cut see the cbd

03:22we can also see the cystic duct and the hilum is also visible and common hepatic duct is also visible

03:29so indosinine green has a great advantage so that it is a near infrared fluorescent colon geography

03:38and both the windows this posterior window is little bit enlarged

03:43and you can clear cut see the inferior surface of the liver

03:47artery and duct is looking green due to the icg

03:51after that here we are using misra's knot that is one very good extra corporeal knot

03:56to ligate the cystic duct

03:59ligating the cystic duct is very good practice to you should keep on practicing it

04:06although the clip also can be used but sometime clip has the

04:10cata stone complication although in the dilated cystic duct this complication is more

04:17but knot is always secure and misra's knot is one one one one one one

04:22one hitch one wind one lock second wind second lock third wind third lock

04:27and we are using here the vandarkar knot pusher which will push the knot and it will be ligated one

04:40knot is more than sufficient it gives you very nice dumbbell formation after that it is cut and we are

04:48applying one clip over the cystic artery also and both the limb of the clip applicator should be visible

04:57and one clip ideally two clips should be applied but here we will use harmonic so harmonic has its own

05:04sealing capacity so you don't need to apply two or three clip because harmonic will seal the

05:12gall wedded side itself even with the harmonic you can do clipless cholecystectomy also

05:19so cystic duct and cystic artery is cut and after that

05:23with anterolateral and anteromedial traction gall wedded will be separated

05:29sometime if you have a proper arional tissue plane then you can do the blunt dissection also

05:35to separate the gall wedded

05:37and slowly you can separate the gall wedded from the bed

05:41so we can see this is a blunt dissection and gall wedded is slowly going out

05:46once you have done half of the gall wedded out light cable of 30 degree telescope should be at

05:51six o'clock position so that you can see up and you can easily separate it once you have done the last

05:58part a final inspection of the gall wedded fossa and cystic pedicle should be done

06:03and then gall wedded should be separated if it is required you may do little folgression if there

06:09is a oozing from the gall wedded bed the folgression can be done so here we can see it is clean there is

06:17no bleeding and then this is little bit mucus will leak because once you aspirate the gall wedded

06:24little leak of the mucus will be there

06:27so this is the final part and now the gall wedded is finally separated from the liver

06:39so now this is over

06:42after that you can bring a claw forcep from the epigastric port

06:47claw forcep is a 10 mm traumatic grasper and you can hold the neck of the gall wedded

06:55and then it can be pulled out through the epigastric port

06:59some people they use through the umbilical port also that is okay all there is no any problem

07:06and this is now slowly it is pulled up and once it is out then because it was punctured due to

07:14aspiration needle so some mucus will leak so once it is taken out then you can do little suction

07:22you can irrigate and suck all the mucus which was leaked due to the puncture of aspiration

07:27through the morrison's pouch

07:31sometime after proper cleaning aspiration

07:35we can use some gilocaine and we can inject the gilocaine or lignocaine over the diaphragm on the right

07:43side to prevent the shoulder tip pain

07:45so this is clean in the morrison's pouch final suction was done and then we will inject the 5 ml

07:55gilocaine or lignocaine over the diaphragm and after that all the instrument is used

08:03it is removed co2 is removed and then slowly telescope will be taken out

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