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Laparoscopic Cholecystectomy Medication

  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
Updated: Aug 05, 2015

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.


Local Anesthetics

Class Summary

Local anesthetic agents are used to increase patient comfort during the procedure.

Lidocaine and epinephrine (Lignospan Forte, Xylocaine with Epinephrine)


Lidocaine is an amide local anesthetic used in a 0.5-1% concentration in combination with bupivacaine (50:50 mixture). This agent inhibits depolarization of type C sensory neurons by blocking sodium channels. Epinephrine prolongs the duration of the anesthetic effects from lidocaine by causing vasoconstriction of the blood vessels surrounding the nerve axons.

Bupivacaine (Marcaine, Sensorcaine)


Bupivacaine 0.25% may be used in combination with lidocaine plus epinephrine (50:50 mixture). It decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.


General Anesthetics

Class Summary

After standard monitoring equipment is attached and peripheral venous access achieved but before the arterial line is inserted, the midazolam or lorazepam dose is administered.

Propofol (Diprivan, Fresenius Propoven)


Propofol is a phenolic compound unrelated to other types of anticonvulsants. It has general anesthetic properties when administered intravenously. Intravenous propofol produces rapid hypnosis, usually within 40 seconds. The effects are reversed within 30 minutes, following the discontinuation of infusion. Propofol has also been shown to have anticonvulsant properties.



Class Summary

Typically, a single dose of a cephalosporin is administered by the anesthesiologist before the skin incision.



Cefazolin is a first-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. It is used for infections caused by gram-positive cocci (except enterococci)



Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who experience moderate to severe pain.

Acetaminophen and codeine (Tylenol #3)


This combination is indicated for mild to moderate pain.

Acetaminophen (Tylenol, Aspirin-Free Anacin, Cetafen, Mapap Extra Strength)


Acetaminophen is the drug of choice for the treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs, as well as in those with upper GI disease or who are taking oral anticoagulants.

Hydrocodone bitartrate and acetaminophen (Vicodin ES, Lortab, Lorcet Plus, Norco, Maxidone)


This agent is indicated for the relief of moderately severe to severe pain.

Contributor Information and Disclosures

Danny A Sherwinter, MD Attending Surgeon, Department of Mimially Invasive Surgery and Bariatrics, Associate Program Director, Department of Surgery, Maimonides Medical Center; Director of Minimally Invasive and Bariatric Surgery, American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence

Danny A Sherwinter, MD is a member of the following medical societies: American College of Surgeons, American Society for Metabolic and Bariatric Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.


Harry L Adler, MD Assistant Clinical Professor of Surgery, Mount Sinai Hospital; Assistant Director and Consulting Physician, Maimonides Medical Center

Harry L Adler, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Surgeons, Association for Academic Surgery

Disclosure: Nothing to disclose.

Sunny Leah Fink, MD Multi-Organ Abdominal Transplant Fellow, Department of Transplant Surgery, University of Pittsburgh Medical Center

Sunny Leah Fink, MD is a member of the following medical societies: American College of Surgeons, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Lee S Cummings, MD Transplant Fellow, Georgetown University Hospital

Lee S Cummings, MD is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Michele F Malit, DO Resident Physician, Department of Surgery, Maimonides Medical Center

Michele F Malit, DO is a member of the following medical societies: American College of Surgeons, American Medical Student Association/Foundation, American Osteopathic Association, American College of Osteopathic Surgeons, Student Osteopathic Medical Association

Disclosure: Nothing to disclose.

Stalin Ramakrishnan Subramanian, MD Resident Physician, Department of Medicine, Brookdale University Hospital and Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.


Jerzy M Macura, MD Chief of Advanced Laparoscopic Surgery, Director of Bariatric Surgery, Maimonides Medical Center

Jerzy M Macura, MD is a member of the following medical societies: American Society for Metabolic and Bariatric Surgery, American Society of Abdominal Surgeons, and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Laparoscopic cholecystectomy. Placement of fascial stay sutures.
Laparoscopic cholecystectomy. Visualization of gallbladder after placement of table in reverse Trendelenburg position.
Laparoscopic cholecystectomy. Advancement of 11-mm trocar under direct vision.
Laparoscopic cholecystectomy. Placement of two lateral 5-mm ports under direct vision.
Laparoscopic cholecystectomy. External view after port placement.
Laparoscopic cholecystectomy. Lateral grasper is used to retract fundus cephalad and retract adhesions.
Laparoscopic cholecystectomy. Medial grasper is applied to infundibulum.
Laparoscopic cholecystectomy. Medial grasper is used to retract infundibulum in caudolateral direction.
Laparoscopic cholecystectomy. Critical view, with only cystic duct and cystic artery seen entering gallbladder.
Laparoscopic cholecystectomy. Use of L-hook electrocautery to score anterior peritoneum.
Laparoscopic cholecystectomy. Division of peritoneum along medial aspect.
Laparoscopic cholecystectomy. Use of Endo Peanut to identify cystic structures.
Laparoscopic cholecystectomy. Use of Maryland dissector to dissect cystic duct.
Laparoscopic cholecystectomy. Use of Maryland dissector to dissect cystic artery.
Laparoscopic cholecystectomy. Continued dissection of critical structures.
Laparoscopic cholecystectomy. Placement of clip at lower aspect of cystic artery.
Laparoscopic cholecystectomy. Placement of superior clips on cystic artery.
Laparoscopic cholecystectomy. Transection of cystic artery with Endo Shears.
Laparoscopic cholecystectomy. Placement of clips on distal cystic duct.
Laparoscopic cholecystectomy. Placement of proximal clip on cystic duct.
Laparoscopic cholecystectomy. View of clipped cystic duct before transection.
Laparoscopic cholecystectomy. Transection of cystic duct between clips with Endo Shears.
Laparoscopic cholecystectomy. Use of hook to develop plane in areolar tissue between gallbladder and liver.
Laparoscopic cholecystectomy. Use of traction and hook to remove gallbladder from gallbladder bed.
Laparoscopic cholecystectomy. Side-to-side sweeping motion with electrocautery to remove gallbladder from gallbladder bed.
Laparoscopic cholecystectomy. Cauterization of any bleeding in gallbladder bed before complete division of gallbladder.
Laparoscopic cholecystectomy. Placement of gallbladder into endoscopic retrieval pouch.
Laparoscopic cholecystectomy. Placement of gallbladder into endoscopic retrieval pouch and removal of instrument from pouch.
Laparoscopic cholecystectomy. Irrigation and suction of gallbladder bed.
Laparoscopic cholecystectomy. Removal of ports under direct vision.
Laparoscopic cholecystectomy. Abdomen after skin closure.
Laparoscopic cholecystectomy. CT scan illustrating biloma.
Laparoscopic cholecystectomy. Postcholecystectomy ERCP showing leak of contrast.
Laparoscopic cholecystectomy. Postcholecystectomy ERCP.
Laparoscopic cholecystectomy. ERCP-guided stent placement.
Laparoscopic cholecystectomy. HIDA scan showing postcholecystectomy leak.
Anatomy of biliary tree.
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