Lesson 1Managin dense inflammation an difficult dissection: subtotal (fenestratin/reeves) cholecystectomy techniques, intraoperative drainage, use a drainsCover strategies fi handlin dense inflammation an tough gallbladder dissection, includin subtotal cholecystectomy types, safe use a energy devices, intraoperative drainage, an reasons fi leavin drains inna place.
Identifying the difficult gallbladder earlyFundus‑first and subtotal cholecystectomy optionsFenestrating versus reconstituting techniquesSafe use of energy in inflamed tissuesDrain placement in difficult dissectionsLesson 2Postoperative care an common complications: bile leak recognition, postoperative antibiotics, drain management, follow-up imagins indicationsCover routine postoperative care after laparoscopic cholecystectomy, early spotin a bile leak an infection, smart antibiotic use, drain reasons an handlin, an criteria fi postoperative imagins an specialist referral.
Standard recovery milestones and discharge criteriaRecognition of bile leak and biloma formationPostoperative antibiotics: when indicatedDrain placement, monitoring, and timely removalIndications for postoperative ultrasound or CTLesson 3Patient positionin an operatin room layout: supine wid reverse Trendelenburg an left tilt, surgeon/assistant/monitor positions fi ergonomicsDescribe best patient positionin fi laparoscopic cholecystectomy, includin supine, reverse Trendelenburg, an left tilt, an detail ergonomic placement a surgeon, assistant, scrub nurse, an monitors fi best view an safety.
Supine and reverse Trendelenburg positioningLeft tilt and table adjustments for exposureSurgeon and assistant standing positionsMonitor height, distance, and alignmentInstrument table and scrub nurse placementLesson 4Control a cystic duct an artery wid basic devices: selection an application a clips, adequate stump length, specimen extraction techniquesExplain safe control a di cystic duct an artery usin clips an basic devices, includin clip pickin, spacin, an stump length, as well as safe cuttin, retrieval, an extraction a di gallbladder specimen inna routine cases.
Choosing clip size and material for cystic structuresNumber, spacing, and orientation of clipsEnsuring adequate cystic duct stump lengthSafe division of cystic duct and arterySpecimen bag use and extraction techniquesLesson 5Port placement an instrument choices: four-port technique (sizes an exact abdominal landmarks), use a traction sutures or retraction methods wid basic toolsDetail standard four-port placement wid precise landmarks, port sizes, an angles, an discuss instrument pickin, includin graspers, dissectors, energy devices, an optional traction sutures or alternative retraction ways.
Umbilical camera port placement and sizeEpigastric working port positioningRight subcostal accessory port landmarksChoice of graspers, dissectors, and scissorsUse of traction sutures for gallbladder fundusLesson 6Exposure a Calot’s triangle an dissection strategies: fundus-first vs antegrade approaches, gentle gallbladder traction, use a blunt an sharp dissection wid electrocauteryExplore techniques fi expose Calot’s triangle safe, comparin antegrade an fundus-first approaches, optimizin traction directions, an usin blunt an sharp dissection wid electrocautery while protectin nearby structures.
Traction directions for optimal Calot’s exposureAntegrade versus fundus‑first dissectionBlunt versus sharp dissection techniquesSafe use of monopolar electrocauteryAvoiding injury to CBD and hepatic arteryLesson 7Contraindications an relative considerations fi laparoscopic cholecystectomy: severe cardiopulmonary disease, uncorrected coagulopathy, unclear anatomy, suspicion a gallbladder cancerOutline absolute an relative no-gos fi laparoscopic cholecystectomy, includin severe heart-lung disease, coagulopathy, unclear anatomy, an suspected cancer, an discuss risk-benefit check an alternative plans.
Absolute versus relative contraindicationsImpact of severe cardiopulmonary diseaseManagement of uncorrected coagulopathyHandling unclear anatomy or prior surgerySuspicion of gallbladder cancer and stagingLesson 8Typical clinical presentation a symptomatic cholelithiasis an chronic cholecystitis: pain pattern, Murphy’s sign, labs an imagins findingsReview typical symptoms an signs a biliary colic an chronic cholecystitis, linkin pain patterns, Murphy’s sign, lab issues, an key ultrasound an CT findings fi guide diagnosis an surgery plannin.
Typical biliary colic pain pattern and triggersMurphy’s sign and focused abdominal examinationLaboratory patterns in acute and chronic cholecystitisUltrasound features of stones and gallbladder wallCT and other imaging roles in equivocal casesLesson 9Critical view a safety: definition, stepwise steps to achieve it, documentation an criteria fi stoppin an convertinDefine di critical view a safety, detail stepwise dissection need fi get it, stress recordin wid images or video, an clear up criteria fi stop dissection, bailout moves, or switch to open surgery.
Formal definition of critical view of safetyStepwise dissection to expose Calot’s triangleConfirming and documenting the critical viewCommon pitfalls and misinterpretationsCriteria for bailout or conversion to openLesson 10Preoperative evaluation fi biliary surgery: LFT interpretation, ultrasound assessment a gallbladder an ducts, indications fi MRCP or ERCP, perioperative antibiotic choicesAddress preoperative evaluation fi biliary surgery, includin readin liver function tests, ultrasound check a gallbladder an ducts, reasons fi MRCP or ERCP, an evidence-based pickin an timin a perioperative antibiotics.
Pattern recognition in liver function testsUltrasound assessment of gallbladder and CBDWhen to order MRCP versus ERCPRisk stratification for choledocholithiasisPerioperative antibiotic selection and timingLesson 11Immediate management a suspected bile duct injury: recognition signs, intraoperative cholangiography considerations, damage-limitation measures, when to call biliary surgery/transferFocus on early spotin a suspected bile duct injury, intraoperative cholangiography options, immediate damage-control plans, recordin, an criteria fi urgent consult or transfer to hepatobiliary center.
Intraoperative signs suggesting bile duct injuryRole and technique of on‑table cholangiographyDamage‑limitation strategies and when to stopDocumentation and communication with the teamCriteria for referral to biliary surgery centersLesson 12Creatin pneumoperitoneum an safe access: open (Hasson) vs Veress needle technique, insufflation pressures, trocar insertion safety checksExplain safe creatin a pneumoperitoneum usin open an Veress techniques, recommend insufflation pressures, trocar insertion angles, avoidin entry complications, an confirm adequate workin space before movin on.
Patient selection for open versus Veress entryVeress needle insertion tests and checksHasson open technique step by stepRecommended insufflation pressures and flowSafe primary trocar insertion and verification
