Surgery Summary

Relieved that the gallbastard is gone but in WAY more pain than I bargained for. Very fatigued as well. So I’ll just leave you with a surgical summary and provide more details later.

Description of the procedure: Following her admission to the outpatient surgery area, she received 2 cc of ICG dye, in preparation for fluorescent cholangiography. She was brought to the operating room and general anesthesia induced. Ancef was administered intravenously as prophylaxis against wound infection.

Abdomen was prepared and draped in the usual sterile manner. Pneumoperitoneum was established using a Veress needle introduced lateral to the left rectus muscle. Intra-abdominal pressure was maintained at 15 mmHg, using carbon dioxide insufflation. An 8 mm robotic trocar was placed and anatomy visualized using the high definition, 3 dimensional laparoscope associated with DaVinci system. Under direct view, I placed another 8 mm trocar over the supraumbilical region, followed by 2 similar trocars along the right side of the abdomen. She was then turned into reverse Trendelenburg position, with the right side tilted up.

The robotic system was docked in place.

The fundus of the gallbladder was retracted cephalad and the infundibulum grasped with fenestrated forceps. Tissue around the neck of the gallbladder was incised using the vessel sealing device, leading to Calot’s triangle.

Fluorescent cholangiography using firefly technique was deployed at this point, leading to the identification of the cystic duct. It was isolated and controlled using locking clips. Cystic artery was controlled using the vessel sealing device. Cholecystectomy was completed using the same device as well. Gallbladder was then placed in an Endo-Catch bag and removed via the supraumbilical trocar site. The fascia over this incision was closed using 1. Vicryl under direct laparoscopic view. Skin incisions were closed using 3 0 Vicryl, in a subcuticular fashion.
Preemptive analgesia was established using 0.5% Marcaine with epinephrine.

She tolerated the procedure well and was taken to the recovery room in a stable condition.