Emergency Cholecystectomy during Pregnancy by Minilaparoscopic Surgery

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Gustavo Carvalho

added:
4 years ago

views:
2300

specialty:
General Surgery

Case description

As we have promissed here is the edited video from the 36 y/o pregnant lady, 30th week, with acute cholecystitis - Several details must be stressed to better undertand our strategy of minimizing trauma and anesthesia for both mother and baby: A- We did a generous infiltrtion at umbilical site and also at every mini- trocar site before insertion (it can be well observed 20-55s) B - We started with 8mmHg of pneumo to esier trocar insertion, but as soon as we finished insertion we reduced the penumo to 6mmHg. C - We opt for the half-dome down mini clipless technique - Alredy well described here in mini friends - as it is more suitable for very small work space. D - Because CO2 started to rise a little at capnography we decreased the already low pneumo to even less to 4mmHg (1:54s - 3:55), helping to stabilize it, you can see how difficult is to navigate with the scope with such small pneum. The use of ENDOCAMELEON optics made it easier with its variable angle E- After dissection of cystic duct and artery to easier our knots we increased pneumo to 6mmHG and it was kept at this level until the end of the procedure. F- Artery was lately taken with electrocuatery, because it was larger than 2mm we used maryland instead of a simple hook, a bipolar if available would be preferred. G- At the end gallbladder was retrieved in a bag,minimizing contamination and risk of rupture. H - Mini instruments were essential to keep the safety of the procedure at a very narrow operative space. HOPE you all enjoy the video

tags: Emergency Cholecystectomy pregnancy Minilaparoscopic Surgery