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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email:drbarnouti@australiaplasticsurgery.com.au
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What is a tummy tuck?

A tummy tuck operation is also known as abdominoplasty. It involves removing excess skin and fat from the stomach area, mainly the lower part of the tummy through surgical procedure. A tummy tuck operation is intended to leave the patient with a flatter tummy and to remove any signs of an 'apron' stomach or an overhang which is sometimes visible above underwear. The skin on this area tends to be stretched and of poor quality. A tummy tuck operation will usually focus on the lower part of the stomach, below the belly button and may require the belly button to be repositioned in some cases. The procedure is often carried out on women or men who have suffered from stretched skin in the stomach area after pregnancy, giving birth, excess fat deposition or weight loss.

What happens during a tummy tuck?

During a tummy tuck procedure the aim of the surgeon is to cut away fat and excess skin. To do this Dr Barnouti will make in incision on the lowest part of the stomach, where a fold will be visible above the pubic bone. He will take out as much excess fat as can be removed and will then cut the skin to fit back over the place where the fat has been removed from. It is important to have realistic expectations of a tummy tuck. Taking too much fat and skin away can result in folds at each end of the resulting scar which are sometimes referred to as "dog ears". Dr Barnouti will make sure you will not have this problem.

Who should have a tummy tuck?

Tummy tucks are recommended for either men or women who have an excess of fat and skin around their abdomen which cannot be removed by weight loss, exercise or liposuction. Tummy tuck operations in women are usually reserved for those who are not likely to have children as it is inadvisable to get pregnant again after having skin removed, this can cause the wound to stretch and scar.

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The total cost is $7,900 if the patient's health fund cover the hospital's fees. In case the health fund does not cover the hospital's fee, the total cost will be around $12,000 inclusive of the Surgeon, assistant surgeon, Anaesthetist, hospital, operating theatre and follow ups visit.

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