Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Extended
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.

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When a stroke affects an extensive portion of the front and back regions of the left hemisphere, the result may be global aphasia. Survivors with global aphasia: May have great difficulty in understanding words and sentences. May have great difficulty in forming words and sentences. May understand some words. Get out a few words at a time. Have severe difficulties that prevent them from effectively communicating.

Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract camera.gif and pass from the body. See a picture of ESWL camera.gif. You lie on a water-filled cushion, and the surgeon uses X-rays or ultrasound tests to precisely locate the stone. High-energy sound waves pass through your body without injuring it and break the stone into small pieces. These small pieces move through the urinary tract and out of the body more easily than a large stone. The process takes about an hour. You may receive sedatives or local anesthesia. Your surgeon may use a stent if you have a large stone. A stent is a small, short tube of flexible plastic mesh that holds the ureter open. This helps the small stone pieces to pass without blocking the ureter.

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To learn more, please visit https://www.upmc.com/services/....liver-cancer/treatme

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Cystic acne is a severe type of acne in which the pores in the skin become blocked, leading to infection and inflammation. The skin condition mainly affects the face, but also often affects the upper trunk and upper arms. Acne most often affects adolescents and young adults, with an estimated 80 percent of people between 11 and 30 years of age experiencing acne at some point. Cystic acne is the most severe form and affects far fewer people. In 2009, the Centers for Disease Control and Prevention (CDC) found that acne was the top reason people gave for visiting a dermatologist.

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Commentary:

0:24
He may not look like he’s in good condition but you can guesst that his somewhere in nirvana at this point
0:44
After the operation, this patient loses more than just color in his skin but apparently he loses his nipples as well
1:43
This sedated patient is equipped with his own hand-gun. No pun intended
2:17
His anesthesia dose came with the usual side effects of crazy talk with a dash of attitude and sarcasm
3:17
The only thing crazier than love is being sedated during an endometriosis surgery
4:36
This may come as a surprise to some but penguins don’t actually reside in Alaska. In case you didn’t know that well now you do
5:09
If the doctor advises you against something you can’t resist doing, how many of us would still listen to him?
6:35
When them meds start kicking in , it’s time to frame this experience as an excuse to divulge some of your secret fantasies
7:05
There’s a time and place dirty jokes but anesthesia told this guy any times the right time
7:24
Her 16 year old son talks about the last thing he remembers right after surgery and this is what he says
8:35
She’s definitely not in the mood at all. I wouldn’t wanna tick her off during this time if I were you
8:44
A feeling of relief after your operation may be followed by some emotional changes such as mood swings and over sensitivity
9:44
Even if you do say something you wouldn't normally say while you are under sedation, according to some doctors, “it's always kept within the operating room”
10:38
The beeping sounds of the medical equipments tip this patient over the edge. so she tries to drown out the noise with her own voice
11:08
Anyone who's received anesthesia can attest to feeling pretty loopy. Although many won't remember it's fairly common to say some wacky things after waking up
11:53
It's typical for people to feel sad or vulnerable after surgery. Kind of like how this girl is feeling right now
12:04
If she wasn’t under the influence in the hospital right now , it would be pretty hard to justify this type of behavior
12:17
Imagine working as an anesthesiologist. You might become numb to a lot of strange behaviors and everything unusual becomes the new norm for you

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The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. The technique has been in practice since the late 1800s, but did not reach widespread acceptance and use until several modifications were described in the 1960s and 1970s. Those modifications came from a desire to make the procedure safer, more reliable, and more predictable with less relapse. Those goals continue to stimulate innovation in the field today and have helped the procedure evolve to be a very dependable, consistent method of correction of many types of malocclusion. The operative surgeon should be well versed in the history, anatomy, technical aspects, and complications of the bilateral sagittal split osteotomy to fully understand the procedure and to counsel the patient.

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