June 28, 2013
The procedure that I am going to discuss is a Laparoscopic Cholecystectomy performed by the Da Vinci robot. So what is the definition of a Laparoscopic Cholecystectomy it is the removal of the gallbladder through an incision port. The wound classification for a Laparoscopic Cholecystectomy is a class II, which is a clean-contaminated procedure. There are many indications for this procedure to be done such as cancer of the gallbladder, and asymptomatic gallstones. The anatomy that is important to know before you begin is the muscles which include; rectus abdominis, transverse abdominal, internal oblique, external oblique, rectus sheath, and linea alba. The nerves include; celiac part of the greater splanchnic nerve and finally the blood vessels are the cystic artery and vein. So when the patient is being prepped the circulator used Chloroprep and the boundaries of the prep area will begin at the nipple line to the groin. The patient will be position in the prone position with extra foam padding for the patients head and elbows. Now before the procedure can begin my role as a scrub to make sure that I have all of the correct supplies, and instruments. First you will need a basic pack, gown, and gloves. Next you will need specialty drapes which includes, Da Vinci arm drapes, laparoscopic drape, Laparoscopic Cholecystectomy Drape, Camera head drape, and Scissor tip probe cover. Other supplies include; light cord, scope warmer, suction irrigator, cannula seal, and basin set. Instruments that you will need is Laparoscopy tray, robotic hook, five mm clip applier, robotic instruments, twelve degree-zero degree scope, number twelve and five trocar, and veres needle.
Extra equipment that is needed for this procedure is cautery, suction, insufflator, camera, monitor, video, and light source. Sutures that will be used are 0-Vicryl on a UR-6 for the fascia, and 4-0 Vicryl on a FS-2 on the skin. The only solution that was on the back table was 0.9% Sodium Chloride. And the dressing that was used is steri-strips, mastisol, and covaderm. The steps for this procedure are as followed; the surgeon makes a small incision above the umbilicus with a #15 blade. The abdomen is inflated with CO2 with the veres needle or a Hassan trocar. A 10mm trocar is then inserted after the veres needle has been removed and the laparoscopic camera and light source is then placed through the 10 mm trocar. When the camera is inserted to give the doctor better visualization on where to place the other three ports. Once the doctor is satisfied the circulator will move the robot towards the umbilical incision site where the camera is hooked up to the robotic arm, along with other forceps, and graspers that will be used in the procedure. Each instrument is inserted and connected to each arm. The doctor will break scrub and head to the console and sit down to control the robotic arms. At the console the doctor can view the operative site in three dimensional and through the hand control the doctor has the ability to be more precise when dissecting down to reveal the gallbladder. After the gallbladder is removed the doctor will rescrub in. And the scrub will remove the robotic instruments and the camera. And the doctor will return to the operative site to remove the gallbladder though the 10mm trocar site. The incision sites are close with sutures.
There are certainly some differences between a Laparoscopic and Robotic Cholecystectomy the first is the price the Da Vinci is clearly more expensive. How every in recent studies the healing rate is much better