Cholecystectomy: Open vs. Laparoscopic Methods

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Questions and Answers

What is the primary purpose of creating a small incision through the abdominal fascia in the Hasson technique?

To enhance visibility of the operative field

To allow for accurate needle placement and trocars (correct)

To facilitate drainage during surgery

To minimize the risk of infection

What alteration in respiratory dynamics is most commonly seen in patients with cholecystitis?

Decreased respiratory rate

Increased tidal volume

Decreased lung compliance (correct)

Improved gas exchange

What is a potential complication of renal insufficiency in patients undergoing cholecystectomy?

Enhanced recovery time

Higher risk of infection

Fluid overload and electrolyte imbalance (correct)

Increased analgesia requirement

Which gas is typically used for insufflation during laparoscopic surgical procedures?

Carbon dioxide Signup and view all the answers

What effect does CO2 absorption during laparoscopic procedures have on the cardiovascular system?

Decreased cardiac output Signup and view all the answers

What is a benefit of laparoscopic surgery compared to open procedures?

Less intraoperative blood loss Signup and view all the answers

Which gastrointestinal pathology is considered a potential complication of cholecystectomy?

Ileus Signup and view all the answers

What technique is often employed to manage decreased intravascular volume status in cholecystectomy patients?

Fluid resuscitation Signup and view all the answers

What components primarily comprise bile?

Bile salts, bile pigments, and cholesterol Signup and view all the answers

Which hormone is responsible for triggering gallbladder contraction?

Cholecystokinin Signup and view all the answers

What is a common indicator of cholecystitis during an abdominal examination?

Murphy sign Signup and view all the answers

What condition results from obstruction of bile flow through the cystic duct or common bile duct?

Cholecystitis Signup and view all the answers

Which factors increase the risk for developing cholecystitis?

Obesity and age Signup and view all the answers

What is indicated by Murphy sign during the examination?

Gallbladder disease Signup and view all the answers

What might cause jaundice if complete obstruction of the cystic duct occurs?

Elevated plasma bilirubin levels Signup and view all the answers

What diagnostic evaluation is used to confirm cholecystitis?

Cholescintigraphy Signup and view all the answers

What percentage of cholecystectomy procedures are performed using the open technique?

Less than 10% Signup and view all the answers

What is one of the primary benefits of the laparoscopic surgical technique compared to the open technique?

Decreased postoperative respiratory dysfunction Signup and view all the answers

Which finding would you expect to see in a patient with cholecystitis prior to cholecystectomy?

Normal coagulation times Signup and view all the answers

What alteration in physiological functioning occurs during laparoscopic cholecystectomy?

Increased pneumoperitoneum Signup and view all the answers

Which of the following is a common medication used by patients undergoing cholecystectomy?

Thiamin Signup and view all the answers

In the context of cholecystectomy, which complication occurs in less than 5% of surgical cases?

Conversion to open technique Signup and view all the answers

What does the gallbladder primarily do?

Stores bile Signup and view all the answers

Which of the following heart rate findings would be considered abnormal in a patient preparing for a cholecystectomy?

120 beats per minute Signup and view all the answers

What condition warrants fluid resuscitation in the absence of other precluding pathophysiologic conditions?

Volume depletion Signup and view all the answers

Which surgical procedure is performed through a right subcostal or midline incision?

Open cholecystectomy Signup and view all the answers

What is the estimated percentage of laparoscopic cholecystectomy procedures that will be converted to an open approach?

Less than 5% Signup and view all the answers

What method is commonly used to confirm proper placement of the Veress needle in laparoscopic procedures?

Feeling a 'pop' sound Signup and view all the answers

What complication can arise from previous abdominal surgeries affecting cholecystectomy?

Increased surgical complexity due to adhesions Signup and view all the answers

Which of the following is NOT a primary effect of free air in the abdomen?

Improved digestion Signup and view all the answers

What complication can significantly affect anesthetic management in patients undergoing surgery?

Obesity Signup and view all the answers

What is the purpose of insufflating carbon dioxide during a laparoscopic cholecystectomy?

To create a pneumoperitoneum Signup and view all the answers

Study Notes

Cholecystectomy: Open and Laparoscopic Approaches

Open cholecystectomy is used in less than 10% of cases, and less than 5% of laparoscopic cholecystectomies are converted to open procedures.
Laparoscopic cholecystectomy offers advantages such as reduced postoperative respiratory dysfunction, pain, and analgesic needs, leading to less lethargy, nausea, vomiting, and constipation.
The gallbladder is a hollow, pear-shaped organ situated on the underside of the right lobe of the liver.
The cystic duct connects the gallbladder to the common hepatic duct, forming the common bile duct.
Bile is produced by the liver and stored in the gallbladder until released into the intestines.
Bile aids in the breakdown and absorption of dietary fat.
Cholelithiasis is the formation of hard masses within the gallbladder, typically composed of bile acids, bile pigments, cholesterol, and calcium.
Gallstones can become lodged in the cystic duct, causing obstruction.
Cholecystitis is an inflammation of the gallbladder resulting from infection, inflammation, and obstruction of bile flow through the cystic duct or common bile duct.
Symptoms of cholecystitis include severe right upper abdominal pain, often radiating to the right shoulder.
Murphy's sign, a diagnostic test for cholecystitis, involves tenderness over the gallbladder when inhaling during palpation.
Blood test results in cholecystitis show increased plasma bilirubin, ALP, and amylase.
Jaundice can occur with complete cystic duct obstruction.
A cholescintigraph, a contrast study of the gallbladder, is used to confirm cholecystitis.
Cholecystectomy can be performed as an open or laparoscopic procedure.
Open cholecystectomy involves a right subcostal or midline incision, with dissection into the peritoneal cavity for exposure of the gallbladder, cystic duct, cystic artery, and common bile duct.
Laparoscopic cholecystectomy involves insufflation of carbon dioxide (CO2) into the peritoneum to create a pneumoperitoneum.
A Veress needle is inserted below the umbilicus into the peritoneal cavity, confirmed by a "pop" sensation and water drop test.
The Hasson technique involves a small incision for trocar placement.
A video laparoscope visualizes the operative field during laparoscopic surgery.

Anesthetic Management and Considerations for Cholecystectomy

Preoperative period:
- Identify common associated disease states in cholecystectomy patients.
- Understand respiratory changes in cholecystitis patients.
- Describe the potential for decreased intravascular volume and its management in cholecystectomy patients.
- Recognize the benefits of laparoscopic surgery over open procedures.
- Be aware of potential for renal insufficiency in cholecystectomy patients.
- Understand potential gastrointestinal pathology in cholecystectomy patients.
- Discuss premedication for cholecystectomy patients.
Intraoperative period:
- Describe the anesthetic technique used for laparoscopic cholecystectomy.
- Carbon dioxide (CO2) is used for insufflation during laparoscopic procedures.
- Understand the effects of pneumoperitoneum on various body systems: cardiovascular, pulmonary, cerebral, renal, and hepatic.
- Discuss the effects of CO2 absorption during laparoscopic procedures.
- Examine the effects of steep reverse Trendelenburg positioning for laparoscopic cholecystectomy.
- Identify the cause and treatment for a sudden decrease in heart rate during CO2 insufflation.
- Recognize potential complications associated with open cholecystectomy.
- List possible complications associated with laparoscopic cholecystectomy.
Postoperative period:
- Identify key aspects of postoperative anesthetic management for open and laparoscopic cholecystectomy.

Review Questions

What gas is commonly used to create a pneumoperitoneum during laparoscopic surgery?
Which hemodynamic change is not associated with a pneumoperitoneum?
What respiratory effect occurs during CO2 insufflation for laparoscopic surgery?

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Description

Explore the key differences between open and laparoscopic cholecystectomy in this quiz. Understand the advantages of laparoscopic approaches and the anatomy involved, including the gallbladder and its connection to the biliary system. Test your knowledge on gallstones and related conditions like cholecystitis.