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Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Extended
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017

AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.

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Live Surgery: Eyelid surgery /Scarless Blepharoplasty (Eye bag removal) performed by Dr Rajat Gupta, Board Certified Plastic Surgeon at RG Aesthetics, Delhi

Pre Surgery Procedure
Before starting the cosmetic surgery the surgeons would do preoperative markings and the marking are done in standing positions and the zones and areas are marked. The markings are done on upper eyelid skin excision, the lower eyelid eye bags also the areas where fat will be used. This fat is harvested from the body wherever the person has the excess fat. The fat is harvested, purified and washed so that pure fat is deposited in the zone, where the person lacks fat .

Eyelid surgery step by step:
1.Before making any incision local anaesthesia is given along with adrenaline. This helps in making the procedure bloodless as well as also makes sure that the patient won't experience any pain after the surgery.
2. The doctor removes excess skin over the upper eyelid which was marked preoperatively and excess eyebags are removed from upper eyelids. These are removed by radiofrequency bipolar forceps so that there is no bleeding.
3. Once the excess eyebags from upper eyelids are removed, the doctor proceeds to lower eyelid surgery. In this doctor performs transconjunctival blepharoplasty. The corneal shield is used to make sure there is no injury to the eyes.
4. An incision is made in the lower eyelid and excess fat is dissected. Later the lower eyelid skin is tightened by removing lower eyelid excess skin and subcuticular suture are given. This incision is made along with the eyelash, hence the scar is never visible
5.At the end the upper eyelid incision is also closed
6.Similarly same steps are repeated at the opposite side.

The stitches in upper and lower eyelids are removed after 4 days. Some fat is put in tear trough region, nasolabial groove, mid cheek zone, just to achieve peri orbital and midface rejuvenation.


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About Dr Rajat Gupta and RG Aesthetics

At RG Aesthetics, India’s best plastic surgeon, Dr Rajat Gupta is at your service! With 10 years of experience, brand-certification, and international recognition, Dr Gupta is the solution to all your contouring needs.

His expertise in liposuction techniques combined with the state-of-the-art technology available at RG Aesthetics ensures we continue providing the most reliable services with incredible, instantaneous results!

Our equipment allows for every kind of liposuction there is – especially the minimal invasive kinds. Dr Gupta reflects RG Aesthetics’ belief of the patient’s comfort always being paramount. Procedures at RG Aesthetics, under Dr Rajat Gupta, minimize trauma and speed up recovery time for the best results!

For more information please visit our website: https://www.drrajatgupta.com/
For more details,
contact us:+91-9251-711-711 or contact@drrajatgupta.com

_______________________________________
About Dr. Rajat Gupta and RG Aesthetics

At RG Aesthetics, India’s best plastic surgeon, Dr. Rajat Gupta is at your service! With 10 years of experience, brand-certification, and international recognition, Dr. Gupta is the solution to all your contouring needs.

His expertise in liposuction techniques combined with the state-of-the-art technology available at RG Aesthetics ensures we continue providing the most reliable services with incredible, instantaneous results!

Our equipment allows for every kind of liposuction there is – especially the minimal invasive kinds. Dr Gupta reflects RG Aesthetics’ belief of the patient’s comfort always being paramount. Procedures at RG Aesthetics, under Dr Rajat Gupta, minimize trauma and speed up recovery time for the best results!

For more information please visit our website: https://www.drrajatgupta.com/
For more details,
contact us:+91-9251-711-711 or contact@drrajatgupta.com


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