Mayo stand and back table instruments for Laparoscopic Cholecystectomy surgery setup

Clamping & Occluding

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  Laparoscopic Clip Appliers

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  Penetrating Towel Clamp

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  Curved Hemostat

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  Kelly Forceps

Cutting & Dissecting

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  L Hook Cautery

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  #3 Knife Handle

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  Laparoscopic Metz Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Toothed Forcep

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  Laparoscopic Wave Grasper

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  Laparoscopic DeBakey Forceps

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  Laparoscopic Maryland Dissector Grasper

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  Adson Forceps

Misc

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  Laparoscopic Aspiration Needle

Retracting & Exposing

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  Army-Navy Retractor

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  Hasson S Retractor

Suctioning

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  Suction Irrigator

Suturing & Stapling

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  Mayo-Hegar Needle Holder

What to expect during Laparoscopic Cholecystectomy

Surgery Steps: A laparoscopic cholecystectomy or lap chole is surgery to remove a gallbladder. With the Laparoscopic Cholecystectomy instruments detailed above, let’s discuss how they are used and when.

The scalpel will be used to make approximately 3-4 incisions to insert trocars. A Verres needle may be introduced into the umbilical incision to introduce CO2 into the abdomen. With this method, a Kelley and two towel clips should be available to insert the Verres needle. A syringe of saline may also be needed after inserting the Verres needle. S retractors or Army-Navys may be used to retract to insert trocars. Another method is to insert a trocar, and then attach the CO2 tubing, achieving pneumoperitoneum. A locking grasper is then used to grasp the gallbladder and retract it. Fat or adhesions can be dissected with graspers, hook cautery, and Maryland. When properly dissected, the gallbladder hilum is visualized along with the cystic duct and artery.

The clip applier will then be used on the cystic artery two times. This is when a cholangiogram may be performed. The laparoscopic scissors will be used to incise the cystic duct. The cholangiogram catheter will be inserted into the duct’s incision, and the clip applier will be used again to hold it in place. Saline and radiopaque dye should be available and drawn up into syringes. X-ray will be used for visualization. The cholangiogram catheter will then be removed, and the clip applier will be used again on the duct. The rest of the gallbladder will then be dissected from the liver, most likely using the hook cautery and wave graspers.

The suction/irrigator should then be used to visualize any bleeding on the liver. An endopouch will then be inserted and the gallbladder will be removed from the port. If there are stones in the gallbladder preventing it from fitting through the port site, the gallbladder may be aspirated, and the stones may need to be removed. Before skin closure, the doctor may use the suction irrigator one last time. The trocars will then be removed, and the port sites will be closed. A needle driver and an adson pick-up will be needed for suturing, and the straight mayo scissors should be available for cutting sutures.

Extra Equipment: Camera, light cord, CO2 tubing, suction tubing, Endopouch, bovie, poss. port closure device, poss. Verres needle, trocars, poss. Cholangiogram device, telescopes, poss aspirating needle

Drapes: Four folded towels and laparotomy drape