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Cholecystectomy

Cholecystectomy is the operation to remove the gallbladder.

This is usually done for acute or chronic inflammation of the gallbladder related to gallstones.

In most cases cholecystectomy is done laparoscopically, but in some circumstances it might have to be done by open laparotomy via a right subcostal incision or an upper midline incision.

Laparoscopic (minimal access) surgery is done through small transverse skin incisions, through which are inserted 5 to 12mm diameter ports (tubes which have a tap and a valve). The abdomen is distended with carbon dioxide delivered through the tap on one of the ports under low (15mm Hg) pressure to create space inside the abdomen. A telescope connected to a light source and a video camera is then inserted through the valve on one of the ports and instruments are then inserted through the other ports.  Laparoscopic surgery has the significant advantages of much reduced surgical trauma with less pain and more rapid return to normal activities and better cosmesis. However, the disadvantages of laparoscopic surgery are that the surgeon a) operates with a very restricted field of vision (can only see what the camera shows); b) has only two-dimensional view (as opposed to 3-dimensional view with open surgery); c) does not have tactile appreciation; and d) uses long instruments with very small working parts, which are not as ergonomically efficient as instruments used in open surgery (like operating with chopsticks!). As a reult there is a slightly increased risk of inadvertent injury to surrounding structures during laparoscopic surgery, as compared with open surgery.