TECHNICUE OF LAP. CHOLE BY. DR . AHMED KENSARAH

Technique of lap chole Grasping forceps are pushing up the fundus of the gallbladder elevating the liver and stretching the gallbladder longitudinally Asecond instrument holds the hartmann’s pouch allowing a good visualization of triangle of calot.

Technique of lap chole This image shows a lateral retraction on the Hartmnn’s pouch, pulling the cystic duct and artery away from hepatic duct. A disector is passed through to isolate the cystic duct from the artery.

Technique of lap chole Once the cystic artery is isolated and cleaned its attachments, the cystic duct is dissected and clearly visualized by pushing backwards the cystic artery and forward the duct in one single manouver.

Technique of lap chle Upon completition of thedissection , clips are applied to the cystic artery and divided with scissors.

Technique of lap chole Now the cystic duct is doubly clipped and then transected with scissors. Electrocautery or laser should not be used to avoid necrosis of tissue under the clips and possible post-operative bile leakage.

Technique of lap chole Dissection is performladdered through each side of the gallbldder dividing the peritoneal reflection. The Hartmann’s pouch is pulled superiorly and medially to permit good field exposure while the gallbladder is being freed from the liver bed it can be removed .