The Spiritual Surgeon

The laparoscopic cholecystectomy may begin.First, insufflation of the abdomen is achieved to 15 mmHg using carbon dioxide. Next, four small incisions are made in the abdomen for trocar placement (supraumbilical x1, subxiphoid x1, and right subcostal x2). Utilizing a camera (laparoscope) and long instruments the gallbladder is retracted over the liver.

This allows for exposure of the proposed region of the hepatocystic triangle. Careful dissection is carried out to achieve the critical view of safety. This view is defined as (1) clearance of fibrous and fatty tissue from the hepatocystic triangle, (2) the presence of only two tubular structures entering into the base of the gallbladder, and (3) the separation of the lower third of the gallbladder from the liver to visualize the cystic plate.