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A growing number of patients having total knee replacement surgery are 55 or younger. Surgeons at Sunnybrook's Holland Centre perform more than 1,000 total knee replacements each year. Read more: http://sunnyview.sunnybrook.ca..../2011/11/snap-crackl
Patient information from Sunnybrook's Holland Musculoskeletal Program. For more, visit: http://sunnybrook.ca/holland
Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Standard
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017
AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri
DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.
MUSC Children’s Health offers South Carolina’s only Level 1 Children’s Surgery Center, representing excellence in inpatient surgery at MUSC Shawn Jenkins Children’s Hospital, as well as outpatient surgery at R. Keith Summey Medical Pavilion. These two state-of-the-art facilities are equipped with a team of pediatric board-certified providers utilizing pediatric-specific devices and the most technologically advanced tools.
Children are not little adults, which is why even the simplest of procedures requires a hospital that is 100 percent dedicated to caring for children. Children’s Mercy is one of only 10 centers in the country to be as recognized as a Level 1 Children’s Surgery Center, the highest possible rating. The result? An organization with pediatrics specialists in every subspecialty that sets the standard of care instead of just practicing it.
Jennifer Lawton, M.D., is professor and chief of the Johns Hopkins Division of Cardiac Surgery, as well as director of the Cardiac Surgery Research Laboratory and program director of the cardiothoracic fellowship training program at Johns Hopkins. Her areas of expertise include valve surgery, including minimally invasive surgery, coronary artery bypass grafting on- and off-pump, all arterial revascularization, as well as surgery for aortic dissection and ascending aneurysm. For more information about Dr. Lawton visit http://www.hopkinsmedicine.org..../heart_vascular_inst