Laparoscopic Cholecystectomy

Gallbladder anatomy

* Calot’s triangle : Cystic duct, CHD, liver의 inf. Border → 이곳에 cystic artery가 존재(Landmark for localizaition of cystic artery)
Calot's triangle : Cysitc duct, Cystic artery, CHD가 이루는 삼각형

* Cholecystectomy의 종류

(1) Open cholecystectomy ; Rt. subcostal incision, laparoscope의 contraindication이나 fail시 open으로 conversion한다. 상처가 크고 통증이 심하며 재원이 길다.

(2) Laparoscopic cholecystectomy ; 3 or 4 port(5-12mm)를 이용. pneumoperitoneum을 만든다. 대부분 의 담낭질환의 surgical treatment of choice.

(3) Single port laparoscopic cholecystectomy & NOTES(Natural orifice transluminal endoscopic surgery) ; emerging technique, 배꼽에 단일 port로 수술 또는 위, 직장, 질, 방광등 자연 개구부를 이용. 아직 비교연구와 기술 개발이 필요.

(4) Robotic cholecystectomy (multiport, single port) 

Laparoscopic cholecystectomy

position:

Patient is operated in the supine position with a steep head- up and left tilt. This typical positioning of laparoscopic cholecystectomy should be achieved once the pneumoperitoneum has been established. The patient is then placed in reverse Trendelenburg’s position and rotated to the left to give maximal exposure to the right upper quadrant.

Reference
- Zollinger's Atlas of Surgical Operations
- Maingot's Abdominal Operations, 12th Edition
- Textbook of Practical Laparoscopic Surgery, 3rd Edition
- Netter's surgical anatomy and approaches