A cholecystectomy is the surgical removal of the gallbladder. Historically, surgeons performed this via the open technique through a 6- to 7-inch incision. Since the 1980s, this has changed to the laparascopic technique in which surgeons use about four small incisions, less than 1/2 inch each, to insert a camera and thin instruments to perform the surgery. The instruments used are specially designed for laparoscopic surgery.
Trocars
Each small incision that is made in the abdominal wall allows a long thin instrument to be inserted. However, a special plastic tube must be placed through each incision to allow this to happen. These tubes are called trocars and range in diameter from 3mm to 12mm. They allow the gas that is needed to expand the abdominal cavity to pass through, while one-way valves prevent gas from escaping. They also allow the instruments to be inserted without losing the gas. Proper trocar placement facilitates the ease of surgery. Poorly positioned trocars will cause the surgeon to have to use instruments at odd angles, making the surgery more difficult.
Video System
The laparoscopic video system is key to laparoscopic surgery as it provides the view of the gallbladder for the surgeon. Historically, the first laparoscopic surgeries were performed without this system. The surgeon would look directly into an eyepiece at the end of a long, thin scope, much like looking through a captain’s spyglass. Now surgeons attach this scope to a digital video camera with a light source. The camera runs into a video system that projects the image onto a screen. The quality of the image depends on the monitor quality, the level of camera definition and other similar factors.
Operating Instruments
The operating instruments used in laparoscopic cholecystectomies mirror those used in the traditional open cholecystectomy except that each instrument is mounted on a long thin shaft which connects the handle to the working part. In most cases, the surgeon will lift and hold the gallbladder with laparoscopic graspers which resemble traditional grasping clamps. Laparoscopic dissectors are used to clear tissue and define anatomy as dissecting clamps would be used in open gallbladder surgery. Laparoscopic electrocautery, scissors and suction are again all replicas of their traditional counterparts except for their thinner diameter and longer length.
Specimen bag
Once the gallbladder is separated from the connecting structures, it is usually removed from the body by placing it into a special specimen bag that is then withdrawn through the bellybutton. The bag resembles a plastic sandwich bag with a drawstring on a slip noose. Using this bag helps prevent infection and spillage during extraction from the body.
