Procedure Note

Specialty of Clinician: Medical Record Administrator Surgeon: Dr. Eleanor Vance Anaesthetic: General Anaesthesia (Propofol, Sevoflurane) Location: St. Jude's Hospital, Operating Theatre 3 Procedure date: 1 November 2024 Procedure name: Laparoscopic Cholecystectomy Indications for Operation: The patient, a 48-year-old female, presented with a 3-month history of recurrent right upper quadrant abdominal pain, radiating to the back, often exacerbated after fatty meals. Clinical findings included tenderness in the right upper quadrant on palpation. Ultrasound imaging revealed multiple gallstones, the largest measuring 1.5 cm, within a thickened gallbladder wall, consistent with chronic cholecystitis. The patient experienced several acute attacks of biliary colic, significantly impacting her quality of life, necessitating surgical intervention. Procedure: * Preparation: Patient was positioned supine on the operating table. Standard anaesthetic monitoring was applied. Skin was prepped and draped in the usual sterile fashion using chlorhexidine solution. * Anaesthesia Details: General anaesthesia was induced using propofol 150mg IV and maintained with sevoflurane and remifentanil. Endotracheal intubation was performed without complication. * Incision Details: A 10mm infraumbilical incision was made for the primary trocar insertion (Hasson technique). Three additional 5mm ports were placed: one in the epigastrium, one in the right subcostal region, and one in the right flank. * Dissection Approach: Following establishment of pneumoperitoneum (12-14 mmHg), exploration revealed a moderately inflamed gallbladder with pericholecystic adhesions. Dissection proceeded carefully to identify and isolate the cystic duct and cystic artery. Calot's triangle was meticulously dissected. * Findings: Intraoperative findings confirmed chronic cholecystitis with multiple cholelithiasis. No overt signs of acute inflammation or common bile duct dilation were noted. Liver appeared normal. * Specimen Characteristics: The gallbladder, measuring approximately 8x4 cm, was removed intact. It contained numerous dark, faceted gallstones ranging from 0.5 cm to 1.5 cm. The wall was focally thickened. * Closure Method: The cystic duct and artery were clipped using three clips proximally and two distally before transection. The gallbladder bed was inspected for haemostasis. All ports were removed under direct vision. The 10mm fascia was closed with 2/0 Vicryl sutures. Skin incisions were closed with 4/0 Monocryl subcuticular sutures. * Dressing Application: Steri-Strips and sterile dressings were applied to all port sites. * Specimen Handling: The resected gallbladder was sent to histopathology for routine examination. * Complications if any: No intraoperative complications occurred. * Estimated Blood Loss: Approximately 20 mL. Plan: The patient was transferred to the post-anaesthesia care unit (PACU) in stable condition. Post-operative care includes routine pain management with paracetamol and ibuprofen, antiemetics as needed, and early ambulation. A light diet will be initiated once fully awake and tolerating oral intake. Discharge is anticipated tomorrow morning, provided the patient is pain-controlled, afebrile, and tolerating fluids. Instructions on wound care and activity restrictions were given. Follow-up with the surgical outpatient clinic is scheduled for two weeks post-operatively. Follow-up appointment details: Surgical Outpatient Clinic, St. Jude's Hospital, 15 November 2024, at 10:00 AM.