Cholecystectomy

Laparoscopic Cholecystectomy

The success of laparoscopic cholecystectomy (removal of gallbladder) initiated the surgical revolution of laparoscopic surgery in the late 1980s . It continues to rank among the most commonly performed laparoscopic surgery procedures in North America."

Approximately 10-15 percent of the adult population or more than 20 million people in the United States have gallstones. About 1 million new patients are diagnosed annually. Gallstones are more common in women, older patients, and certain ethnic groups, and are associated with multiple pregnancies, obesity, and rapid weight loss. In 1991 approximately 600,000 patients underwent cholecystectomy.

Most patients with gallstones remain symptom-free for many years and may, in fact, never develop symptoms. Asymptomatic patients usually develop symptoms before they develop complications. Therefore, with few exceptions, patients with asymptomatic gallstones should not be treated. Once symptoms appear, they recur in the majority of patients. Furthermore, patients with symptoms secondary to gallstones are more likely (25 percent within 10-20 years) than asymptomatic patients to develop complications. Thus, most symptomatic patients should be treated. Pain from gallstones ('biliary pain') is often severe, episodic, lasting 1 to 5 hours, often waking the patient at night, and located above the bellybutton ('epigastric') or in the right upper quadrant of the abdomen. Biliary pain often flares soon after eating. Some patients present with atypical signs and symptoms such as bloating, indigestion, reflux, nausea, loss of appetite and inability to tolerate the fatty foods. Nearly 90 percent of patients with typical biliary pain are rendered symptom free after successful treatment of their gallstones. Those who are too ill to undergo surgery should be treated with medical therapy.

Until late 1980`s, the prevailing surgical treatment of symptomatic gallstones was an open operation through a large abdominal incision to remove the gallbladder. Since the advent of laparoscopic cholecystectomy in 1988, this procedure has become the gold-standard for gallbladder removal. Most patients with symptomatic gallstones are candidates for laparoscopic cholecystectomy, if they are able to tolerate general anesthesia and have no serious cardiopulmonary diseases or other coexisting conditions that preclude operation.

Laparoscopic Cholecystectomy Procedures

Laparoscopic cholecystectomy is performed by making four incisions in the abdominal wall. Using the laparoscope and other instruments the gallbladder is removed through one of the small incisions. The operation requires general anesthesia and is subject to the same risks and complications as open cholecystectomy.

Before the surgeon removes the gallbladder, patient may have a special X-ray called intraoperative cholangiography, which shows the anatomy of the bile ducts or common bile duct stones.

In about 5% of cases, a surgeon who starts a laparoscopic surgery gallbladder procedure needs to switch to an open surgical method that requires a larger incision. Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, common bile duct injury,  bleeding, unclear anatomy, portal hypertension, being in the third trimester of pregnancy , Scar tissue from previous abdominal surgeries, a severe lung disease, such as emphysema, and gallstones in the common bile duct. Conversion to open cholecystectomy is not regarded as a complication of laparoscopic cholecystectomy but instead reflects the exercise of appropriate judgment in successfully and safely accomplishing the procedure. The Robotic surgery need to be done by a Robotic Expert Surgeon with knowledge in robotic and laparoscopy procedure.

The overall risk of laparoscopic gallbladder surgery is very low. The most serious possible complications include Infection, bleeding, damage to the internal organs like major blood vessels, bowel, bile duct, biliary leak , requirement for re-operation, transfusion, or ERCP, complication of anesthesia, like heart attack, stroke, pulmonary emboli, deep venous thrombosis, pneumonia, post-operative bowel obstruction and incisional hernia.

You may have gallbladder surgery as an outpatient, or you may stay 1 day in the hospital.
After surgery you may have pain in the right shoulder and upper right abdomen that lasts 24 to 72 hours, widespread muscle aches from anesthesia, temporary diarrhea, minor inflammation, swelling or drainage at the surgical wound sites, loss of appetite and some nausea and bloating for few days.

Most people can return to their normal activities within a week to two weeks. People who have laparoscopic gallbladder surgery are sore for about a week, but within 2 to 3 weeks they have much less discomfort than people who have open surgery and they can go back to regular work and exercise. No special diets or other precautions are needed after surgery.

More recently, removal of gallbladder can be performed through a single incision using robotic system. The da Vinci System is a robotic surgical platform designed to enable complex procedures of all types to be performed. The Da Vinci robotic system has designed a special single incision port that enter the abdominal cavity through a small intra-umbilical incision and allows the special curved robotic devices to enter the abdomen for removal of the gallbladder. Also a hernia repair is perform by robotic system. There have been some potential benefits experienced by surgeons using the da Vinci Surgical System over traditional laparoscopic approaches. These benefits are much less pain, virtually scarless, even faster recovery and high patient satisfaction.

At NEWPORT LAPAROSCOPY, Dr. Iraniha a Robotic Surgery Expert performs single incision robotic cholecystectomy. After a thorough evaluation, Dr. Iraniha will determine whether Single incision Robotic cholecystectomy is appropriate for a particular patient's situation. Call our office today to make an appointment with Dr. Iraniha