Periprocedural Care
Equipment
Equipment for open cholecystectomy includes instruments common to a major instrument tray, as follows:
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Kelly clamps, Kocher forceps, needle holders, scissors, clips, suctions, knife/knife handles, forceps, retractors, right angle clamps, Kitner dissectors, and electrosurgical devices should be assembled
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Balfour retractors, Bookwalter retractors, or other self-retaining retractors can be used, according to the surgeon's preference
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Sutures or clips can be used to control the cystic duct and artery, depending on the surgeon's preference and the size of the structures (see Technique); long instruments may be needed, depending on the body habitus of the patient
A headlight worn by the operating surgeon or assistant is often valuable in open cholecystectomy for improving visualization.
Several types of cholangiography catheters are available if cholangiography is to be performed.
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Patient Preparation
Anesthesia
Most open cholecystectomies are performed with general anesthesia. Less commonly, the procedure is done with regional (epidural or spinal) anesthesia; in rare instances, it is done with local anesthesia.
Positioning
Patients are positioned supine with the arms extended. Placing a folded blanket or bump underneath the patient's right back or inverting the table may be beneficial.
Previous
Media Gallery
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Anatomy and exposure for an open cholecystectomy. Placing packs above liver for improved visualization.
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Exposure for open cholecystectomy.
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Anatomy, exposure, and beginning of dissection for retrograde technique of open cholecystectomy.
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Beginning of dissection for retrograde technique of open cholecystectomy.
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Dissecting gallbladder off liver bed in retrograde technique.
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Completion of dissection of gallbladder off of liver bed in retrograde technique.
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Ligation of cystic duct and artery in retrograde technique of open cholecystectomy.
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Completion of retrograde technique of open cholecystectomy showing ligated cystic artery and cystic duct.
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Anterograde technique for open cholecystectomy.
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Retrograde technique for open cholecystectomy.
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