Laparoscopic cholecystectomy

Be mindful of any anatomical variations such as an aberrant right hepatic artery traversing along the right side of the CBD posteriorly. The RHA can also be adjacent to the cystic duct in 50%.

Aberrant biliary anatomy includes short cystic duct, long cystic duct (spiral or parallel). Rarely a right sectoral duct may join the junction of cystic and CHD or traverse across the liver substance and join the left sided ducts.

For GB bed bleeding: if arterial bleeding will respond to diathermy, if venous then need to apply pressure with gauze or surgicell

5mm epigastric port with 5mm clipper. Pass GB through umbilical port with medial port grasper

Problems
1.Avulsion of cystic duct
Keep the rest of the GB on the liver so that you can use it for retraction
Try to find cystic duct stump
Use 3-0 prolene suture on the edge of the remnant duct then bring up through the epigastric port
Use stay suture to help guide the cholangiogram catheter
Transfix the end using a 3-0 prolene suture

2. Large stones
Get extra large sucker that has side holes / scoop

3. Port site bleeding
? Endoclose
? suture intra corporealally

4.Acutely inflamed GB
10mm RUQ port
Always decompress GB
Mother in law grasper to grab GB
Sucker for blunt dissection