Cholecystectomy

Question 1

… (ICG) fluorescence imaging to enhance biliary anatomy visualization during gallbladder removal.

Answer 1

Indocyanine Green

(The liver absorbs ICG and excretes it into bile, making the biliary anatomy glow under near-infrared (NIR) imaging)

Question 2

Why is ICG flourescence imaging used?

Answer 2

Helps to identify the cystic duct, common bile duct and hepatic ducts
reduces risk of bile duct injury

(especially helpful if there is lots of scaring, obesity, or prior surgery)

Question 3

what are the steps to RAL cholecystectomy?

Answer 3

1. reverse trendelenburg w/left tilt
2. port placement
3. ID critical structures
4. Critical View of Safety (CVS)
5. Cystic Duct & Artery Ligation
6. GB Dissection from Liver Bed
7. Specimen removal (umbilical port)
8. Irrigate, hemostasis, close

Question 4

Critical View of Safety (CVS)

Answer 4

Identify & clear the hepatocystic triangle (cystic duct, cystic artery, liver edge)

Question 5

Persistent RUQ pain after cholecystectomy + jaundice → …(2 most-likely complications)

Answer 5

1. bile duct injury
2. retained stone

Question 6

What are the 5 MC complications of RAL Cholecystectomy?

Answer 6

1. Bile duct injury
2. Hematoma
3. Bowel or liver injury
4. Port-site Hernia
5. Post-cholecystectomy syndrome

Question 7

RUQ pain + fever + jaundice (charcot’s triad) → … (most likely diagnosis)

Answer 7

Suspect ascending cholangitis

Question 8

ascending cholangitis tx

Answer 8

IV antibiotics + ERCP

Question 9

If bile duct injury is suspected postoperatively (cholecystectomy) → Order … or … to assess bile leak.

Answer 9

• MRCP
• HIDA scan