Lesson 1Managing dense inflammation and difficult dissection: subtotal (fenestrating/reeves) cholecystectomy techniques, intraoperative drainage, use of drainsCovers ways to handle heavy swelling and tough gallbladder separation, including partial removal methods, safe use of heat tools, drainage during surgery, 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 normal after-surgery care after laparoscopic gallbladder removal, early spotting of bile leak and infection, sensible use of antibiotics, when and how to handle drains, and reasons for scans after and seeing specialists.
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 laparoscopic gallbladder removal, including flat on back, reverse Trendelenburg, and left tilt, and ergonomic spots for surgeon, helper, nurse, and screens to improve 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 control of the cystic duct and artery using clips and simple tools, including choosing clips, spacing, stump length, safe cutting, getting out, and removing the gallbladder in normal 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 placing with exact body marks, sizes, and angles, and talks about choosing tools like graspers, dissectors, heat devices, and optional pull stitches or other ways to hold back with simple tools.
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 ways to safely show Calot’s triangle, comparing forward and fundus-first methods, best pull directions, and using blunt and sharp separation with heat while guarding nearby parts.
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 full and partial reasons not to do laparoscopic gallbladder removal, like serious heart-lung illness, untreated clotting issues, unclear body layout, and suspected cancer, and discusses weighing risks and other 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 and signs of painful gallstones and ongoing gallbladder inflammation, linking pain types, Murphy’s sign, lab changes, and main ultrasound and CT results to guide diagnosis and surgery plans.
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, details step-by-step separation to get it, stresses recording with pictures or video, and clears up when to stop separation, use backup plans, 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 choicesAddresses checks before biliary surgery, including reading liver tests, ultrasound check of gallbladder and tubes, when to do MRCP or ERCP, and choosing and timing antibiotics around surgery based on evidence.
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 early spotting of possible bile duct harm, options for dye tests during surgery, quick damage control, recording, and when to call liver-bile experts or move to a special 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 12Creating pneumoperitoneum and safe access: open (Hasson) vs Veress needle technique, insufflation pressures, trocar insertion safety checksExplains safe making of belly gas space using open and needle methods, suggested gas pressures, trocar entry angles, avoiding entry problems, and confirming good work space before going 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
