Lesson 1Managing dense inflammation and difficult dissection: subtotal (fenestrating/reeves) cholecystectomy techniques, intraoperative drainage, use of drainsCovers ways to handle heavy inflammation and tough gallbladder separation, including partial removal methods, safe energy tool use, theatre drainage, and when to leave drains in 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 and common complications: bile leak recognition, postoperative antibiotics, drain management, follow-up imaging indicationsCovers standard after-surgery care post keyhole gallbladder removal, spotting bile leaks and infections early, smart antibiotic use, drain care, and when to do follow-up scans or refer.
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 positioning and operating room layout: supine with reverse Trendelenburg and left tilt, surgeon/assistant/monitor positions for ergonomicsDescribes best patient position for keyhole gallbladder removal, flat on back with head-up and left tilt, and ergonomic spots for surgeon, helper, nurse, and screens for clear views and 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 of cystic duct and artery with basic devices: selection and application of clips, adequate stump length, specimen extraction techniquesExplains safe cystic duct and artery control with clips and basic tools, clip choices, spacing, stump length, safe cutting, and gallbladder removal in 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 and instrument choices: four-port technique (sizes and exact abdominal landmarks), use of traction sutures or retraction methods with basic toolsDetails standard four-port setup with exact body marks, sizes, angles, tool picks like graspers, dissectors, energy devices, and pull stitches or other retraction with basic kit.
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 of Calot’s triangle and dissection strategies: fundus-first vs antegrade approaches, gentle gallbladder traction, use of blunt and sharp dissection with electrocauteryExplores safe exposure of Calot’s triangle, forward vs fundus-first methods, best pull directions, blunt and sharp dissection with cautery while guarding 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 and relative considerations for laparoscopic cholecystectomy: severe cardiopulmonary disease, uncorrected coagulopathy, unclear anatomy, suspicion of gallbladder cancerOutlines no-go and caution cases for keyhole gallbladder removal, like serious heart-lung issues, clotting problems, unclear structures, or cancer suspicion, with risk-benefit checks and options.
Absolute versus relative contraindicationsImpact of severe cardiopulmonary diseaseManagement of uncorrected coagulopathyHandling unclear anatomy or prior surgerySuspicion of gallbladder cancer and stagingLesson 8Typical clinical presentation of symptomatic cholelithiasis and chronic cholecystitis: pain pattern, Murphy’s sign, labs and imaging findingsReviews usual symptoms of gallstone pain and chronic gallbladder inflammation, linking pain types, Murphy’s sign, lab changes, and key ultrasound/CT findings for diagnosis and surgery planning.
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 of safety: definition, stepwise steps to achieve it, documentation and criteria for stopping and convertingDefines the critical safety view, step-by-step dissection to get it, recording with photos/video, and when to stop, bail out, 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 for biliary surgery: LFT interpretation, ultrasound assessment of gallbladder and ducts, indications for MRCP or ERCP, perioperative antibiotic choicesCovers pre-op checks for bile duct surgery, reading liver tests, ultrasound of gallbladder/ducts, when for MRCP/ERCP, and evidence-based antibiotic picks and timing.
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 of suspected bile duct injury: recognition signs, intraoperative cholangiography considerations, damage-limitation measures, when to call biliary surgery/transferFocuses on quick spotting of bile duct injury suspicion, dye scan options, immediate damage control, records, and when to call liver-bile experts or transfer.
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 12Creating pneumoperitoneum and safe access: open (Hasson) vs Veress needle technique, insufflation pressures, trocar insertion safety checksExplains safe belly gas creation with open Hasson or Veress needle, ideal pressures, trocar angles, avoiding entry issues, and confirming space before going ahead.
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
