AB003. 89. Not all plain sailing, lessons in laparoscopic cholecystectomy from a 6-month rotation

Background: Cholecystectomy is one of the most commonly performed abdominal surgeries in the Western world and over 90% are performed laparoscopically. It is also one of the first laparoscopic procedures that surgical trainees will be allowed to undertake. Despite being an extremely effective and well tolerated procedure, serious complications still occur in 2.6% of cases.

Methods: Every laparoscopic procedure at our institution is routinely recorded. We searched the laparoscopic cholecystectomy recordings from a 6-month period from January–July 2018 and selected 6 videos that we felt highlighted some important lessons that should be considered when performing this procedure.

Results: The first video shows the management of a difficult dissection when traditional techniques either fail or are not appropriate. The second video demonstrates how to manage an arterial bleed in the setting of equipment malfunction. The third video explores different options available when presented with an obstructed gallbladder that is difficult to grasp or retract. The fourth video is of a gallbladder volvulus 5. The fifth video illustrates the management of an intra-operative bile leak. The final video is an example of a near miss in the setting of aberrant biliary anatomy.

Conclusions: Laparoscopic cholecystectomy is well established as the gold standard treatment for most gall bladder disease and is a procedure frequently undertaken by surgical trainees. Whilst often straightforward, complications, unusual findings and abnormal anatomy are not uncommon and should always be considered when attempting the procedure.

Keywords: Cholecystectomy; laparoscopic; biliary