Technical note safe and effective laparoscopic cholecystectomy

Author Introduction Preface Acknowledgement Chapter 1 Towards safe and effective laparoscopic cholecystectomy 1 What is safe and effective laparoscopic cholecystectomy? 1 Anatomical landmarks for safe cholecystectomy 4 Calot’s triangle Critical view of safety Actual 3-D triangle for safe cholecystectomy Chapter2 Laparoscopic Cholecystectomy Conventional 4-port technique 11 OR set-up 12 Ports placement 13 A-port placement: C-port placement: B-port placement: Surgeon’s posture and handling instruments 18 How to handle trocar for port placement How to hold laparoscopic instruments Surgeon’s posture performing laparoscopic cholecystectomy Retraction of the gallbladder and securing the Calot area 22 What if the gallbladder is too distended or hard/thickened to be handled by laparoscopic instruments through C-port? Design for surgical procedures 26 Isolation and control of the cystic duct and cystic artery 32 Cystic duct isolation: Cystic duct control: Cystic artery control: -Avoid False Calot -How to use scissors -How to use the clip -Grasper Opening-Retraction Technique -Grasper Opening-Dissection Technique -Avoid “Back-Burn Injury.” Removal of gallbladder from the liver bed This is not the end! Do your best all the way to the end of the surgery! -Hepatic vein running superficially in the gallbladder bed Chapter3 Laparoscopic Cholecystectomy Technical variation 1 “Suction technique” 53 Ready for surgery Suction technique: Chapter4 Laparoscopic Cholecystectomy Technical variation 2 “Partial cholecystectomy using the partitioning method and primary repair of cystic duct” 57 Indication 57 OR setting: Port-placement 58 Surgical Concepts & Surgical Procedures 59 -Partial cholecystectomy vs. Subtotal cholecystectomy Chapter5 Laparoscopic Cholecystectomy Technical variation 3 Artisential® Cholecystectomy (Single-port+1 technique) 65 What is Artisential®? 67 Artisential® instruments 70 Advantages of Artisential® 72 Disadvantages of Artisential® 73 OR setting for Artisential® cholecystectomy 76 Port-placement and preparation 77 Single-port insertion 78 Arrangement of surgical instruments within single port 79 Dissection technique 82 Artisential® Bipolar fenestration forceps Artisential® monopolar hook Artisential® medium-sized clip applier Conventional 5-mm dissector (surgical tie) Conventional 5-mm scissors Conventional 5-mm suction: Gallbladder detachment from the liver bed 89 Author’s comments on Artisential® laparoscopic cholecystectomy 90 Prospects for Korean multi-joint multi-degree-of-freedom laparoscopic surgical instrument(Artisential®) 91 -Artisential® makes us ONE! Chapter6 How to avoid bile duct injury during laparoscopic cholecystectomy Mechanism and Prevention 99 Level-1 102 Level-2A 103 Level-2B 104 Level-3 105 Level-4 106 Level-4S (S, special) 107 Level-O (O, others) 109 Chapter 7 Summary Toward safe and effective laparoscopic cholecystectomy 113 Closing Remarks 119 Videos 122

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