Laproscopic Cholecystectomy General Surgery PowerPoint Presentation
- 1. MEDICAL PRESENTATION On, Laparoscopic Cholecystectomy (surgery) By, Alina Noorain 2nd year BPT rep. blue house (VARUNA) HERITAGE CITY GROUP OF INSTITUTIONS
- 2. Laparoscopy : ★ Also known as KEYHOLE SURGERY. ★ A surgical procedure. ★ Access to the inside of the abdomen and pelvis. ★ No large incisions are made.
- 3. (i) Instruments: a)Laparoscope: ★ a small tube that has a light source and a camera. ★ It relays the images getting captured inside of the abdomen or pelvis, onto a television monitor. b) Graspers c) Dissectors d) Scissors e) Clip appliers f) Cholangiography equipment
- 4. (ii) Benefits: a) Faster recovery time. b) Shorter hospital stay. c) Post-operative condition: less pain and less bleeding. d) Reduced scarring.
- 5. iii) Commonly used in: a) GYNAECOLOGY: endometriosis, fibroids, ovarian cysts, etc. b) UROLOGY: renal cyst surgery, radical cystectomy, etc. c) GASTROENTEROLOGY: fecal diversion, laparoscopic cholecystectomy, etc
- 6. iv) COMPLICATIONS: a) Minor: ★ Infection. ★ Minor bleeding around the incision. ★ Nausea. a) Serious: ★ Damage to organ. ★ Damage to major artery. ★ Entrance of gas bubbles into arteries and veins. ★ Development of blood clots.
- 7. (i) ANATOMY: a)Introduction: ★ SIZE: length- 7 to 10 cms; diameter- 4cms. ★ SHAPE: pear. ★ It is entirely surrounded by PERITONEUM. ★ LOCATION: in the upper right part of the abdomen and sits just under the liver. Gallbladder
- 8. b)RELATIONS:
- 9. ★ FUNDUS: rounded and distal portion in contact with the inferior surface of liver. ★ BODY: largest portion which lies in contact with the posteroinferior surface of the liver, transverse colon and the superior part of the duodenum. ★ NECK: becomes continuous with the biliary tree. ★ BILIARY TREE: directs the secretions from the liver, gallbladder and pancreas into the duodenum. c)PARTS:
- 10. d) THE SUPPLY AND DRAINAGE: ★ BLOOD SUPPLY: cystic artery- branch of the right hepatic artery. ★ VENOUS DRAINAGE: cystic vein- drains into the portal vein. ★ NERVE SUPPLY: coeliac plexus- sympathetic & sensory innervation; vagus nerve- parasympathetic innervation. ★ LYMPHATIC DRAINAGE: cystic lymph nodes.
- 11. (ii) BIOCHEMISTRY: ★ The liver produces a fluid called BILE. ★ It is made up of 70% bile salts/acids, 10% cholesterol, 5% proteins, 5% phospholipids; 1% bilirubin, water, bicarbonate, electrolyte. ★ The bile is drained into the gallbladder through the common hepatic duct which then joins the cystic duct. ★ Finally, reaching the gallbladder.
- 12. (iii) PHYSIOLOGICAL FUNCTIONS: ★ Bile is stored by the gallbladder. ★ Before you start eating, your gallbladder is full of it. ★ When you start eating, your gallbladder receives the signal (cholecystokinin- a hormone) to contract. ★ It is then squeezed out through the biliary tract to the common bile duct. ★ And later released into the 1st part of the small intestine (duodenum). ★ It mixes with the yet-to-be digested food and breaks down fats. ★ The gallbladder resembles a deflated balloon, waiting to be filled again.
- 13. Gallstone a) INTRODUCTION: ★ Pebble-like objects made up of bile material that develop in the gallbladder or the bile ducts. ★ Their size varies from a grain of a sand to a size of a golf ball. ★ Types of stones are: CHOLESTEROL STONES and BILIRUBIN STONES. ★ Bilirubin stones are dark brown or black in colour. ★ Cholesterol stones are yellow- green in colour.
- 14. b) PATHOPHYSIOLOGY: ★ The liver over-produces more cholesterol than the bile can dissolve and there is presence of excess bilirubin. ★ This leads to crystallization of the cholesterol by precipitation. ★ The crystals form into gallstones. ★ The crystals also are formed when the salts/acids or phospholipids are not enough in amount to keep the cholesterol in control. ★ Or when the gallbladder is not emptied, basically gallbladder stasis causes cholesterol to separate and precipitate hench gallstones get formed.
- 15. c) SYMPTOMS: ★ Upper right abdomen pain. ★ Nausea ★ Vomiting ★ Pain in the right shoulder ★ Or pain in-between two shoulder blades (irritation of phrenic nerve) ★ Chills ★ Fever ★ Jaundice ★ Belching
- 16. ★ CHOLECYSTITIS: occurs in the cystic duct. ★ CHOLEDOCHOLETHI ASIS: occurs in the bile duct. ★ CHOLANGITIS: occurs in the duodenum. ★ CHOLETHIASIS: occurs in the gallbladder. dd) Types:
- 17. e) DETECTION: ★ Done with the help of an x-ray. ★ Cholesterol stones are rare and are not easily spottable. ★ Gallstones which are a mixture of cholesterol and calcium carbonate are spottable. ★ The calcium is an electrolyte part, which is opaque and is thus visible on the x-ray. ★ The bilirubin stones are spottable because of the opacity of the calcium in it and bilirubinate part is unconjugated.
- 18. Laparoscopic Cholecystectomy a) SEROLOGICAL TESTS: ★ Blood work- for complete blood count and detection of Hepatitis B and HIV. ★ Urine analysis- to check for the urine sugars, urine proteins and uterine tract infections (UTI’s). b) RADIOLOGICAL TESTS: ★ Abdominal ultrasound scan. ★ Computerised Topography (CT). ★ Magnetic Resonance Imaging (MRI).
- 19. c) GENERAL SURGERY RISKS: ★ Serious allergic reaction to anaesthesia. ★ Internal adhesions from scar tissue. ★ Excessive bleeding. ★ Wound infection. ★ Pneumonia. ★ Uterine Tract Infection (UTI). ★ Perforation in bowel.
- 20. d) BEFORE SURGERY: ★ Pre-anaesthetic check-up for allergies. ★ Drugs like Aspirin, Warfarin are asked to be stopped taken a few days beforehand. ★ The patient isn’t given food 6 hours before the surgical procedure. ★ The patient is then finally given the anaesthesia so he falls asleep and doesn’t feel the pain during the surgery.
- 21. e) DURING SURGERY: ★ The surgery begins. ★ The surgery lasts for 1-2 hours. ★ 2 to 4 number of small incisions of the size 0.4 to 0.6 inches are made in the abdomen by the surgeon. ★ Thin, hollow tubes are inserted through the incisors. ★ A laparoscopy and other surgical tubes are placed into the tubes. ★ Carbon dioxide is pumped into the abdomen which inflates the surgical area and hence makes it easier to see inside.
- 22. ★ Using special tubes the gallbladder is detached from the rest of the body and removed out. ★ The incisors are closed with stitches or surgical clips or surgical glue by the surgical team. ★ During the procedure, if any complications occur, then the surgeon will make bigger icisions, and perform an open cholecystectomy. f) AFTER SURGERY: ★ The surgical team will wait for you to wake up from the anaesthesia rather than wake you up after the surgery to ensure there are no complications. ★ The heart rate, blood pressure and the ability to urinate is checked. ★ You may get a sore throat and if so then you’ll be advised pain killing medicine like ethidin and pentanol.
- 23. Summary: ★ Laparoscopy is a type of surgery done with the help of small incisions and not big cuts using a laparoscope. ★ In laparoscopic cholecystectomy, the gallbladder is taken out due to the infilling of gallstones in the gallbladder. ★ The recovery rate of the surgery is 2 weeks. THANK YOU.