What does laparoscopic cholecystectomy look like?

(4) Surgical procedures

① Make pneumoperitoneum. An arc incision is made along the lower margin of the umbilicus, about 10mm long. If the lower abdomen has been operated, the upper margin of the umbilicus can be used to avoid the scar of the original operation and the skin can be cut.

The surgeon and the first assistant lift the abdominal wall from both sides of the umbilicus with cloth forceps. The surgeon holds the Veress needle with the right thumb and index finger, and thrusts it vertically or slightly diagonally into the abdominal cavity with the force of the wrist.

In the process of puncture, the needle broke through fascia and peritoneum twice. Determine whether the tip has entered the abdominal cavity. Can be attached to the syringe with normal saline, when the needle tip in the abdominal cavity, negative pressure. Connect the pneumoperitoneum machine, if the inflation pressure is not more than 1.73kPa, it indicates that the pneumoperitoneum needle is in the abdominal cavity. Start filling should not be too fast, using low flow inflation, 1 ~ 2L per minute.

At the same time observe the abdominal pressure of the pneumoperitoneum machine, the pressure should not exceed 1.73kPa when inflating, too high indicates that the position of the pneumoperitoneum needle is incorrect or the anesthesia is too shallow and the muscle is not loose enough, and appropriate adjustment should be made. When the abdomen begins to swell and the liver dullness boundary disappears, it can be changed to high-flow automatic inflation until the predetermined value (1.73 ~ 2.00kPa) is reached. At this time, the inflation is 3 ~ 4L, and the patient's abdomen is completely uplifted, and the operation can be started.

Lift the abdominal wall with towel forceps at the umbilical pneumoperitoneum needle and puncture the abdominal wall with a 10mm trocar. The first puncture has certain "blindness", which is a more dangerous step in laparoscopy, so extra caution should be taken. Rotate the trocar slowly, and insert the needle evenly with force. When entering the abdominal cavity, there is a sudden feeling that the resistance disappears. When opening the closed air valve, gas can escape, which means the puncture is successful. Connect pneumoperitoneum machine to maintain constant pressure in abdominal cavity. Then the laparoscope is put in and the puncture at each point is carried out under the supervision of the laparoscope.

Generally, puncture is performed 2cm below the xiphoid process, and cannula is placed 10mm to prepare discharge coagulation hook, clamp applicator and other instruments. A trocar puncture with 5mm was performed 2cm below the costal margin of the right midline of the clavicle, or 2cm below the outer margin of the rectus abdominis muscle and 2cm below the costal margin of the axillary front, respectively, to place the rinse device and the gallbladder fixed gripper. By this time the artificial pneumoperitoneum and preparations were completed.

Due to the manufacture of pneumoperitoneum and the first trocar puncture, the large vessels and bowel in the abdominal cavity can be accidentally injured, and it is difficult to find during the operation. More recently, many people have made a small incision in the umbilical cord, found the peritoneum, and inflated the trocar directly into the abdomen

If you have any questions, please contact us. Our company can produce various customized needles, medical needles, puncture needles, hypodermic needles, biopsy needles, vaccine needles, injection needles, syringe needles, veterinary needles, pencil point needle, ovum pick up needles, spinal needles, etc. If you need customized needle products, please contact us. We look forward to your inquiry! The quality of the products manufactured in our factory will surely satisfy you!

Please contact us if you need: zhang@sz-manners.com