TECHNICUE OF LAP. CHOLE - PowerPoint PPT Presentation

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TECHNICUE OF LAP. CHOLE

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TECHNICUE OF LAP. CHOLE BY. DR . AHMED KENSARAH Technique of lap chole Grasping forceps are pushing up the fundus of the gallbladder elevating the liver and ... – PowerPoint PPT presentation

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Title: TECHNICUE OF LAP. CHOLE


1
TECHNICUE OF LAP. CHOLE
  • BY. DR . AHMED KENSARAH

2
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.

3
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.

4
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.

5
Technique of lap chle
  • Upon completition of thedissection , clips are
    applied to the cystic artery and divided with
    scissors.

6
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.

7
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 .

8
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