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HOW I DO IT / HOW I DID IT SURGICAL PROCEDURES |
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CHOLECYSTECTOMY
§ Patient supine under SAB § Asepsis- Antisepsis § Sterile drapes placed § Right Kocher incision done on the skin carried and down to the subcutaneous tissue § Rectus sheath cut and opened § Rectus abdominal muscle divided with electrocautery § Posterior rectus sheath picked up and cut § Peritoneum identified cut and entered § Pass a hand over the right lobe of the liver and pulled it down § Palpated gallbladder, confirming the presence of stones § Intra op findings noted § Gallbladder is grasp with forceps and retracted laterally § Put a finger into the foramen of Winslow and palpate the common bile duct for stones and the head of the pancreas for any mass § Sharp and blunt dissection on the peritoneum overlying the Calot’s triangle done § Cystic artery identified, clamped and suture ligated. § Cut the peritoneum overlying the fundus of the gallbladder and identify the blue submucosal space § Dissection of the gallbladder from the liver bed carried down to peritoneal reflection overlying the Calot’s triangle § Identify the common bile duct/cystic duct junction § Cystic duct identified, clamped, and suture ligated proximally and distally § Gallbladder removed § Hemostasis done § Peritoneal toilette done § Layer by layer closure © Peritoneum closed by continuos interlocking sutures using Vicryl-0 © Fascia closed by continous interlocking sutures using Vicryl-0 © Subcutaneous closed by Inverted T sutures using Chromic 2-0 © Skin closed subcuticularly using vicryl 4-0. § Dry Sterile Dressing applied § Patient tolerated the procedure well § Post-op condition- stable |