The case of the week - November 8, 2007
Nov 8th, 2007 by Terry
The laparoscopic cholecystectomy (removing the gall bladder via 4 small abdominal holes)
If Sushruta could only see surgery today, his turban would probably be twirling. Even as recently as 20 years ago, who would have imagined having your gall bladder removed via 4 small sholes on your belly and being sent home later that day? Minimal pain? Minimal scars? Impossible!
Welcome to the state of the art. When “lap chole” surgery (as we like to call it) was first introduced, there was a serious learning curve transpiring for the surgeons. It was not unusual for a case to last 3 hours or more. Today, 45 minutes is about average.
The surgeon starts at your navel, making a small incision through which a camera at the end of a long probe is inserted. After your abdomen has been insufflated, three other holes are created that allow access for the other tools for cutting, coagulating, irrigating, suctioning, and retrieving/grasping.
All work inside the abdomen is transmitted to a couple of screens in the room, usually located near the head of the bed. In the early days of lap chole surgery, these screens were TV-type screens that sat atop tall towers of cumbersome equipment. Today, everyone in the case watches the operation on LCD screens suspended from ceiling or wall mounts. Very slick with beautiful screen resolution.
General anesthesia is the “sleep du jour” for lap chole surgery. You must be immobile and painfree during the case in order to optimize gall bladder visualization and removal. After I induce a deep sleep and apnea in You, I carefully insert an endotracheal tube into your windpipe that will help me to both control your breathing and airway, and deliver inhalation agents as part of your anesthetic. [NOTE: said breathing tube goes in AFTER you are asleep and is removed BEFORE you awaken].
Pain medication, muscle relaxation, and anti-emetics are titrated as needed during the case. The amount of pain expected from this type of gall bladder removal is considered mild. And compared to the 6″ diagonal incision along the upper abdomen that accompanies the more traditional opening of the abdomen for a cholestectomy - what a long way we’ve come. Patients used to endure almost a week’s hospitalization after an open gall bladder surgery, and one to two months’ worth of recuperation. Today, most patients can go home at the end of the day after their lap chole, on mild pain medication, and can expect to resume their diet and mild activities as tolerated.
The future is here, and laparoscopic surgery is a huge benefit to all. Huge strides continue to come up on the laparoscopic horizon, and we are all the beneficiaries.
Almost 20 years ago I had to search to find a surgeon who had the experience and the confidence to remove a cyst laparoscopically, there by sparing myself abdominal surgery, a lengthy recovery , and streaks of scar tissue. I’m relieved to hear how much this field has come along since then.
Hello
Do you use a scoring system to find you is more susceptible to PONV, and give antiemetics from that, or do you use a standard protocol? Just interseting to see how things have evolved since I wrote my in-depth thesis on scoring systems in 2001…
hilde
I am amazed at how surgery has changed. I was had one of the “old-fashioned” gall bladder removals in 1985. I was in the hospital for 6 days. I had a tube in my nose to remove all my stomach stuff. (Ick) I remember frequent shots of narcotic pain-killers. I did not feel normal for about 6 weeks.
In contrast, my niece had hers out about 2 years ago. Home the same day and back to school within a week.
Keep up your good work. If I hadn’t been a music teacher, I would have gone into medicine. I am fascinated by the miracles performed every day.
Very cool! Thanks for posting this! We just had one of our case manager RNs have a regular chole and she was out eight weeks. She did lose a lot of weight, but what a way to lose it! Those lap choles also have much less noticeable scars.
That is amazing! Being able to go home the same day after abdomine surgery!
[…] The Case of the Week […]
Laparoscopic cholecystectomy certainly has its advantages. And I think, less complications, too. I do hope more improvements will be done to this procedure.
Here it is January 2008. I am scheduled to have a lapchole this coming Wednesday (Jan 9/08). It has been a long haul, almost 4 years to the date that I started having abdominal pains. After test after test and no diagnosis my MD sent me for “”child abuse” counselling. I am in my 60’s and changed doctors. Then within 2 months I had the gallbladder diagnosis. Should write the previous MD and fill them in that humans have a gallbladder.
Anyway not looking forward to it as they will send me home right after and I am living alone and do not ever ask people for favors so shall look after myself as good or as bad as it can. It would have bene nice to not have to worry the first night but money is always a big factor where I live.
Moico, I certainly hope that all goes well for you. You may be surprised at how well you feel and how functional you will be post-operatively. The biggest complaint that usually is heard is about shoulder pain as the result of some residual carbon dioxide sitting under the diaphragm, but that usually subsides within the first 12 hours.
Best of luck.
Wow, I did not know that I had a breathing tube during my operation. My throat wasnt sore or irratated at all.