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Contemporary Surgery WEBSURG VIDEO TIPSLaparoscopic cholecystectomy: Full skeletonization of Calot’s triangleDidier
Mutter,
MD, PhD;
Jacques
Marescaux,
MD, FRCSStrasbourg, France 263Laparoscopic cholecystectomy: a gold standard case for the dissection of Calot’s triangle vd01en2317http://www.websurg.com/ref/contemporary-vd01en2317.htm
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D Mutter (France) / J Marescaux (France)English15'2008-04-09
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This authoritative demonstration clearly shows all the key steps of laparoscopic cholecystectomy for symptomatic cholelithiasis.
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Case historyTrocar placementOperative anatomyFull skeletonization of Calot\'s triangleClipping and division of cystic duct and arteryDissection of gallbladder from liver bedHemostasis of liver bedExtraction of gallbladderFinal check and removal of trocarsGeneral and digestive > Gallbladder > Cholecystitis > Cholecystectomy
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Fast Track
The posterior approach to laparoscopic cholecystectomy provides good exposure very close to the gallbladder neck and with clear visualization of all the anatomy.
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Opening the lower part of the peritoneum, the authors gain access behind the gallbladder to lengthen Calot’s triangle and reach the cystic duct and artery. Their dissection progresses posteriorly, and they lengthen Calot’s triangle to avoid blunt or blind dissection and bleeding. The surgeon must take care to avoid contact with the right hepatic artery. The posterior approach provides good exposure very close to the gallbladder neck with clear visualization. With gentle traction, they mobilize the cystic duct lateral to the common bile duct, lengthening the cystic duct gently to allow safe application of the clips. The authors carefully dissect the hilar plate to preserve it as the dissection moves close to the gallbladder.
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