General and Gastrointestinal Surgery

Laparoscopy Q&A

What is laparoscopic surgery of the gallbladder?

Laparoscopy is a means of vision.  Rather than making a large incision and looking directly into your abdomen, we make small incisions of 5 to 10 mm (1/5 to 2/5 in.) and use a telescope to see inside your abdomen. The scope is attached to a camera that lets us operate while watching on a television screen.
The actual operation is done the same way but rather than using a 6 to 8 inch incision as for open surgery, we use four small incisions in laparoscopic surgery: two that are 5 mm (1/5 in.) and two that are 10 mm (2/5 in.).We then pass tubes through these incisions to allow access into the abdomen and expand the abdomen with carbon dioxide gas to provide us a space to work in. Our hands never enter the abdomen. Instead, we use long instruments to perform the surgery that we pass through the small tubes. One might compare laparoscopic surgery to open surgery like eating with chop sticks as compared to a knife and fork!  Usually, laparoscopic cholecystectomies take about 45 minutes to an hour.

How does my gallbladder come out of that small incision?

We grab the gallbladder,  once it has been disconnected from the liver, and bring it up to the skin. A little bit of your gallbladder will poke out through the small incision in your skin.  We then make a small incision in the gallbladder itself and aspirate (suck) the liquid (bile) that is in it. That shrinks your gallbladder to a size that will often come out through the incision. You can imagine this if you think of a balloon that is full of water. If you pull it through a small hole it won't come out because the water stops it. If you take out the water though, it will shrink down and easily come out. Sometimes the stones prevent the gallbladder from coming out.  In that case, we take the stones out, one at a time, or break them up into pieces and then take them out.  Rarely, we need to make the incision a little large to get your gallbladder out. This most commonly happens when the gallbladder is very inflamed.

What happens if stones fall out or bile is spilled?

Usually there is no spillage of stones or bile into the abdomen. However, when there is, we make sure to clean it up. We remove any stones that have fallen out and we wash the area where the bile was spilled. It is extremely rare for either of these to lead to any problem after surgery.

Can all patients have a laparoscopic cholecystectomy?

Yes and no.  All patients can have an attempt at laparoscopic cholecystectomy but not all will be completed that way. Overall, about 99% of patients with gallbladder disease will be able to have the procedure completed laparoscopically.

What factors make me a less than optimal candidate?

There are a variety of factors which decrease the chance of the surgeon being able to complete the procedure laparoscopically. 

These include:
   ·   too much inflammation
   ·   previous surgery
   ·   unclear anatomy
   ·   pregnancy
   ·   common duct stones
   ·   previously unrecognized abnormalities
   ·   an intraoperative problem, such as bleeding

Conversion of a laparoscopic procedure to an open one should not to be viewed as a complication, since some patients simply are unable to be have the surgery performed laparoscopically without undue risk. Our goal is to perform a safe and uncomplicated procedure. Therefore, we will not take unnecessary risks just to complete the procedure laparoscopically.

What is the recuperation for laparoscopic surgery?

The major advantage of laparoscopic surgery over open conventional surgery is the significantly shorter recuperative period.  This derives from the smaller incisions used.  Patients usually go home a few hours after surgery following laparoscopic cholecystectomy.  Many patients are able to do normal daily activities that day, such as shopping or going to a movie.  However, most people require 2 to 3 days to return to normal.  In addition, although some patients return to work in 3 to 4 days, most go back one to two weeks after surgery.

Am I asleep during the laparoscopic cholecystectomy?

Yes. Laparoscopic cholecystectomy requires general anesthesia. You will be asleep and completely unaware of what we are doing.  During the operation, a small tube will be placed into your stomach via your mouth and another into your bladder. In addition, the standard breathing tube will be placed into your windpipe. All these tubes will be removed at the end of the procedure before you are fully conscious.

I am afraid of anesthesia.  Is it safe?

Yes. More about anesthesia

Are there risks to this type of surgery?

Like all surgery, there are risks. The first risks are related to the initiation of the laparoscopy. A needle is placed into the abdomen at the belly button. Although precautions are taken to avoid injury, approximately one in 1000 patients will have a resultant injury to the intestine or blood vessel. If this should occur, the surgeon may need to convert the operation to an open one to correct the problem.

In addition to the usual complications of surgery, such as bleeding and infection, injury to the common bile duct is possible. Although rare after open procedures, initial reports suggest that the incidence is greater after laparoscopic cholecystectomies. This finding, however, is related to the experience of the surgeon. The incidence of this injury after the surgeon has performed approximately 30 cases is the same as after open cholecystectomy

More about the gallbladder and gallstones