Abdomen of a 45-year-old male approximately one month after a laparoscopic<unk> . Surgical incision points are highlighted; the one at top right is barely visible. The gall bladder was removed via the incision at the navel. There is a fourth incision (not shown) on the person's right lower flank, used for draining. All incisions have healed well and the most visible remaining effect of surgery is from the pre-operative hair removal. Steps of a<unk> , as seen through a laparoscope. The 1-week-old incisions of a post-operative laparoscopic<unk>  as indicated by red arrows. The 3 abdominal incisions are approximately 6mm, while the fourth incision near the umbilicus is 18mm, each closed with dissolvable sutures. Minor inflammation can be seen surrounding each site due to skin irritation caused by removal of Tegaderm dressings. Pre-operative preparation Before surgery, a complete blood count and liver function tests are usually obtained. Prophylactic treatment is given to prevent deep vein thrombosis. Use of prophylactic antibiotics is controversial; however, a dose may be given prior to surgery to prevent infection in certain people at high risk. Gas may be removed from the stomach with an OG or NG tube. A Foley catheter may be used to empty the patient's bladder. Laparoscopic<unk>  Laparoscopic<unk>  uses several (usually 4) small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10 mm in diameter, through which surgical instruments are placed into the abdominal cavity. The laparoscope, an instrument with a video camera and light source at the end, illuminates the abdominal cavity and sends a magnified image from inside the abdomen to a video screen, giving the surgeon a clear view of the organs and tissues. The cystic duct and cystic artery are identified and dissected, then ligated with clips and cut in order to remove the gallbladder. The gallbladder is then removed through one of the ports. As of 2008, 90% of<unk> es in the United States were done laparoscopically. Laparoscopic surgery is thought to have fewer complications, shorter hospital stay, and quicker recovery than open<unk> . Single incision Single incision laparoscopic surgery (SILS) or laparoendoscopic single site surgery (LESS) is a technique in which a single incision is made through the navel, instead of the 3-4 four small different incisions used in standard laparoscopy. There appears to be a cosmetic benefit over conventional four-hole laparoscopic<unk> , and no advantage in postoperative pain and hospital stay compared with standard laparoscopic procedures. There is no scientific consensus regarding risk for bile duct injury with SILS versus traditional laparoscopic<unk> . Natural orifice transluminal Natural orifice transluminal endoscopic surgery (NOTES) is an experimental technique where the laparoscope is inserted through natural orifices and internal incisions, rather than skin incisions, to access to the abdominal cavity. This offers the potential to eliminate visible scars. Since 2007,<unk>  by NOTES has been performed anecdotally via transgastric and transvaginal routes. As of 2009 the risk of gastrointestinal leak, difficulty visualizing the abdominal cavity and other technical limitations limited further adoption of NOTES for<unk> . Open<unk>  In open<unk> , a surgical incision of around 8 to 12 cm is made below the edge of the right rib cage and the gallbladder is removed through this large opening, typically using electrocautery. Open<unk>  is often done if difficulties arise during a laparoscopic<unk> , for example, the patient has unusual anatomy, the surgeon cannot see well enough through the camera, or the patient is found to have cancer. It can also be done if the patient has severe<unk> cystitis, emphysematous gallbladder, fistulization of gallbladder and gallstone ileus,<unk> ngitis, cirrhosis or portal hypertension, and blood dyscrasias. Biopsy After removal, the gallbladder should be sent for pathological examination to confirm the diagnosis and look for any incidental cancer. Incidental cancer of the gallbladder is found in approximately 1% of<unk> es. If cancer is present in the gallbladder, it is usually necessary to re-operate to remove parts of the liver and lymph nodes and test them for additional cancer. Post-operative management After surgery, most patients are admitted to the hospital for routine monitoring. For uncomplicated laparoscopic<unk> es, people may be discharged on the day of surgery after adequate control of pain and nausea. Patients who were high-risk, those who required emergency surgery, and/or those undergoing open<unk>  usually need to stay in the hospital several days after surgery.
Cholecystectomy
Cholecystostomy
Cholecystenterostomy
Biliary endoscopic sphincterotomy
Endoscopic retrograde cholangiopancreatography
Perihepatic packing
Pancreatectomy
Appendectomy