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Laparoscopic Cholecystectomy

By

Catherine Spader, RN

What is a laparoscopic cholecystectomy?

A laparoscopic cholecystectomy is the surgical removal of your gallbladder through several small incisions and a laparoscope. A laparoscope is a long, thin camera that allows your doctor to see the surgical area on the video screen during gallbladder removal. Your doctor may recommend a laparoscopic gallbladder surgery if you develop gallstones (cholelithiasis) that cause pain. 

The gallbladder is located in the upper right side of your abdomen under the liver. The pear-shaped gallbladder is a hollow sac that concentrates and stores bile produced by the liver. Bile moves from the gallbladder through the bile duct into the small intestine during digestion. A gallstone can move from the gallbladder and block a bile duct, causing irritation, pain and swelling of the gallbladder (cholecystitis) .

A laparoscopic cholecystectomy—as called lap cholecystectomy—is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a laparoscopic cholecystectomy.

Other procedures that may be performed

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Your doctor may perform other procedures in addition to a laparoscopic cholecystectomy. Other procedures may include:

  • Endoscopic retrograde cholangiopancreatography (ERCP) locates and removes a gallstone that is stuck in the bile duct. It involves using an endoscope to access the bile duct. An endoscope is a long, lighted camera that transmits pictures of the inside of your body to a video screen during surgery. Your doctor will pass the endoscope down your throat and through the stomach into the small intestine. Your doctor will remove the stone through the endoscope. 

  • Laparoscopic common bile duct stone extraction is another procedure used to locate and remove a gallstone that is stuck in the bile duct. It involves inserting surgical instruments through small abdominal incisions and remove the stone through the bile duct with a small basket or crush the stone.

  • Open surgery involves making a larger incision that allows your doctor to directly see and remove the gallbladder. It is possible that your doctor may decide after beginning a laparoscopic cholecystectomy that you require open surgery to complete your surgery. 

Why is a laparoscopic cholecystectomy performed? 

Your doctor may recommend a laparoscopic cholecystectomy to treat diseases and conditions of the gallbladder and sometimes the pancreas. Your doctor may only consider surgery for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a laparoscopic cholecystectomy.

Your doctor may recommend a laparoscopic cholecystectomy to treat:

  • Cholecystitis, which is inflammation of the gallbladder resulting in severe pain called biliary colic. A gallstone that gets stuck in a bile duct that that carries bile to or from the gallbladder causes cholecystitis.

  • Choledocholithiasis, which is a gallstone that moves into the bile duct. In some cases, the gallstone will pass by itself. If it gets stuck in the bile duct it can cause inflammation of the gallbladder and possibly the pancreas. 

  • Cholelithiasis (gallstones) in the gallbladder, if they cause frequent or severe pain

  • Gallbladder mass, which can be due to gallbladder cancer or from a benign (noncancerous) tumor

  • Gallstone pancreatitis, which is inflammation of the pancreas caused by a gallstone that gets stuck or passes through the bile duct. A gallstone in the bile duct can also block the pancreatic duct. The pancreatic duct carries digestive juices from the pancreas.

  • Perforated gallbladder, which is leaking or bursting of the gallbladder

  • Biliary dyskinesia, occurs when the gallbladder does not empty bile correctly. This can cause symptoms similar to cholecystitis.

Who performs a laparoscopic cholecystectomy?

A general surgeon performs laparoscopic cholecystectomy. A general surgeon specializes in the surgical treatment of a wide variety of diseases, disorders and conditions. 

How is a laparoscopic cholecystectomy performed?

Your laparoscopic cholecystectomy will be performed in a hospital. Your surgeon will make four small incisions in your upper abdomen and insert tiny instruments and a laparoscope through the incisions. A laparoscope is a long, thin camera that transmits pictures of the inside of your body to a video screen. Your surgeon sees the surgical area on the video screen while performing the surgery.

Dye may be injected via a catheter into the bile duct to confirm the anatomy and to ensure that no stones are in the common bile duct. After the dye injection and X-ray, the gallbladder duct is clipped and the gallbladder removed from one of the small openings.

Surgeons sometimes combine laparoscopic cholecystectomy with open surgery. Open surgery involves making a larger incision to directly view and treat the surgical area. 

Your doctor may decide after beginning your laparoscopic cholecystectomy that you require an open surgery to safely and most effectively complete your surgery.

Types of anesthesia that may be used

Your surgeon will perform laparoscopy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

What to expect the day of your laparoscopic cholecystectomy

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a laparoscopic cholecystectomy? 

Laparoscopic cholecystectomy generally involves a faster recovery and less pain than open surgery to remove the gallbladder. This is because it causes less trauma to tissues and organs. Your doctor will make small incisions instead of a larger one used in open surgery. He or she can thread the surgical tools around muscles and organs instead of cutting through or displacing them as in open surgery.

Despite this, laparoscopic surgery involves risks and possible complications.  Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

Conditions that increase your risk of complications include severe gallbladder inflammation from gallstones, severe obesity, and abdominal adhesions (scar tissue) from prior surgeries.  

General risks of surgery

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing 

  • Bleeding, which can lead to s