Laparoscopic Cholecystectomy

Patient Education > Gallbladder > Laparoscopic Cholecystectomy

Why is the Procedure Performed?

Cholecystectomy is performed when a physician concludes that the gallbladder is diseased, not functioning properly and/or contains gallstones. The gallbladder is removed to avoid further complications such as bile duct obstruction which can affect the liver, infection, or injury to other surrounding organs (pancreas, duodenum).

The laparoscopic method of cholecystectomy is performed as a way to avoid, if possible, the major abdominal incision required for standard open gallbladder removal, as well as to have minimal bleeding during the operation process. The major abdominal incision in regular gallbladder removal procedures is the principle cause of an extended recovery period.

What is Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy is the complete removal of the gallbladder without a major abdominal incision. "Cholecystectomy" is the surgical removal of the gallbladder and "laparoscopic" refers to the type of instrumentation and procedure used for this operation.

The procedure is performed in the operating room while the patient is under a general anesthetic. The incisions used are three small puncture wounds of about ¼ to ½ inch in size which are made below the right rib margin. An additional forth incision is near the umbilicus (belly button) through which the laparoscope is inserted into the abdomen. The three punctures along the ribs are used for placement of the instruments for removing the gallbladder and taking x-rays, if necessary.

The laparoscope is a long, narrow instrument consisting of a lighted tube with magnifying lenses to serve as a surgical viewing scope. It is attached to a small television camera in order for the surgeons and all assistants to view the gallbladder on an external video monitor during the procedure.

The gallbladder is a sack attached to the underside of the liver which stores bile. There are two major structures attached to the gallbladder: the cystic artery which supplies blood to the gallbladder and the cystic duct which transports bile from the gallbladder to the small bowel (duodenum).

Metallic surgical clips are placed on the duct and artery leading to the gallbladder in order to secure the structures against leakage or bleeding. Then an instrument heated by electric current is used to cut the attachments of the gallbladder from the liver bed. The gallbladder is then removed from the abdominal cavity through one of the incisions. This incision may be enlarged slightly if the gallstones are large.

The time required to complete this procedure varies from ¾ of an hour to 2 ½ hours, depending primarily on the size of the gallbladder and the amount of inflammation or swelling present.

Converting to "Open" Procedure During the Laparoscopic Cholecystectomy

In some cases, circumstances may arise during the procedure which may cause the surgeon to abandon the laparoscopic technique in favor of an "open" cholecystectomy procedure performed through a standard incision. Some of the circumstances that may require conversion to an open procedure include failure to properly visualize vital structures, injury to bile ducts or other organs, excessive bleeding, intense inflammation or scarring of the gallbladder or stones in the main (common) bile duct. The same anesthetic is used, but the surgeons must make another type of incision and alter their methods of gallbladder removal.

Benefits/Advantages of Laparoscopic

The advantages to the patient derived from removing the gallbladder by the laparoscopic method, in contrast to other cholecystectomy removal procedures, are:

Reduced pain
Shorter hospital stay (out-patient or one-day stay)
Earlier return to full activity and work
Less pain medication requirement
Less visible abdominal scars

Risks Involved in the Laparoscopic Procedure

The major risks associated with this procedure are similar to those with open cholecystectomy. While the likelihood of occurrence is low, certain risks do exist. The most common risks include:

Bleeding
Hernia
Infection
Complications related to general anesthetic (including the rare incidence of heart attack, stroke, or death)
Injury to the bile duct which could require major reconstructive procedures/reoperation.
Blood clots forming in the legs
Leakage of bile from the bile ducts into the abdomen
Injury to abdominal organs from the laparoscopic insertion

All of the above risks, except the last one, are present with any method of gallbladder removal.

Alternative Treatments

Other methods for treatment of the diseased gallbladder also exist. These methods include removal, dissolving or breaking up of the gallstones without gallbladder removal via:

Use of medications or chemicals to dissolve stones
Shock waves passed through the skin to break up stones (called lithotripsy)
If the gallbladder is not removed, though, there is a distinct possibility that stones will reform in the gallbladder and symptoms will continue or recur.

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