Operative Note – Standard Surgical Procedure

Operative Note – Standard Surgical Procedure Procedure Name and Indication: Laparoscopic Cholecystectomy for symptomatic cholelithiasis. The patient presented with recurrent episodes of right upper quadrant pain, nausea, and occasional vomiting, consistent with biliary colic. Ultrasound imaging confirmed multiple gallstones and a thickened gallbladder wall. This procedure was performed in a regional hospital setting. Date, Team, and Anaesthesia: 01/11/2024. Primary Surgeon: Dr. Sarah Davies. Assistant Surgeon: Dr. Emily White. Anaesthetist: Dr. James Brown. Type of anaesthesia: General anaesthesia. Performed in a regional hospital. Patient Positioning and Site Preparation: Patient was placed in the supine position. Abdomen was prepped with chlorhexidine solution. The surgical site was marked pre-operatively as per local theatre protocol, specifically in the right upper quadrant. Surgical Steps and Intraoperative Details: Standard four-port laparoscopic technique was employed. A 10mm umbilical port was used for the camera. Two 5mm working ports were placed in the right upper quadrant and one 5mm port in the epigastrium. Calot's triangle was meticulously dissected, and the cystic duct and cystic artery were identified, clipped using titanium clips, and divided. The gallbladder was then dissected from the liver bed using electrocautery. Minimal bleeding encountered. A standard laparoscopic cholecystectomy surgical kit was utilised. No specialised equipment was required. Findings and Key Observations: The gallbladder was distended and inflamed with a thickened wall, consistent with chronic cholecystitis. Multiple cholesterol stones, the largest measuring approximately 1.5 cm, were present within the lumen. No evidence of common bile duct dilatation or stones. Liver appeared unremarkable. Complications and Intraoperative Management: No intraoperative complications such as bleeding, injury to bowel, bladder, or major vessels were observed. Anaesthetic course was stable throughout the procedure. No conversion to open surgery was necessary. Closure and Postoperative Plan: Gallbladder was extracted through the umbilical port using an endo-bag. Fascial defects at the 10mm port site were closed with Vicryl sutures. Skin incisions were closed with subcuticular Vicryl and Steri-Strips. Dressings applied. Post-operative care instructions include routine analgesia (paracetamol and ibuprofen), oral antibiotics (Amoxicillin/Clavulanate for 5 days), and early mobilisation. Patient was transferred to the general ward in stable condition. Post-operative review arranged for 24 hours post-surgery.