Avoid mistakes in Laparoscopic Cholecystectomy narrated

[@Holism1]

Gratitude and many thanks to the surgeon who shared this very demonstrative video.

[@ashwinthangavelu]

Yes sharing complications takes a lot of courage and it will act as a wonderful case study for others on how to identify problems and avoid them as well

[@geilkaushik]

Grateful to the Surgeon, who shared this video and Ashwin sir for making us understand the mistakes.

[@ashwinthangavelu]

I am grateful to the surgeon as well for sharing. Thank you

[@rajeevgupta9979]

Very nice sir. Keep yourself above the Rouvius Sulcus. Never clip any tubular structure until CVS is achieved. Overconfidence always sucks you, little underconfidence or overvigilance is the main weapon one carries in his armour to keep the mistakes away.

[@PravinChandran1983]

Must to be seen by all youngsters / this may teach them anatomy/wisdom better than seeing 100 s of perfect cholecystectomies in KZbin / thanks for the primary surgeon for giving permission to share👍 and thanks dr Ashwin for the voice over 👍 Bottom line - any surgeon may / can do major mistakes / few times in a career

[@ashwinthangavelu]

Thank you for your honest comment

[@qaiserktk1]

Love you Sir for the lovely commentary on that particular case. It can happen with anyone, no matter how much experienced one is but that video whoever has watched wil remind that mistake.

[@Abi-ho5gu]

Thank you Sir for sharing this case. ❤ to Primary surgeon as well. One of My Teacher says, when the case looks easy, Be more Vigilant and careful. Thank you again.

[@ashwinthangavelu]

Very true especially in Lap Cholecystectomy

[@VamsiKrishna-gg9um]

Very well explained sir... Basic rules are so imp in lap chole that however bad the anatomy is... U go through it easily if u follow the basic steps

[@OSMANYT-hf9ci]

good video to remind us what we should do to avoid CBD injury

[@ashwinthangavelu]

Thank you for the feedback

[@DrAbuUnplugged]

did he coverted it to an open and did a hepatico jejunostomy? telling the post surgical reconstruction did to the patient would have been awesome

[@ashwinthangavelu]

Converted and Open HJ with the help of an HPB specialist

[@dralimuradkhan5119]

Excellent

[@ashwinthangavelu]

Thanks

[@ancadanielasimion9004]

Congratulations!

[@ashwinthangavelu]

Thank you

[@mraj1271]

Thanks for sharing

[@ashwinthangavelu]

My pleasure

[@vikrantp8]

Very well explained sir

[@kamaldutta6052]

Thankyou sir

[@vishnuvardhan8631]

Good morning sir... After cutting CBD, it also falls slight laterally... Is same for both cystic duct n cbd sir??

[@ashwinthangavelu]

Commonly it gets retracted and more central, whereas cystic duct is floppy and falls well to the right.

[@hassansidahmedmohamedosman1005]

THEN HOW THE SURGEON MANAGE THE PATIENT? PRIMARY REPAIR OF CBD OR HEPATOJEJUNOSTOMY? COPLETED LAPAROSCOPALLY OR CONVERTED? THANK YOU.

[@ashwinthangavelu]

Converted to open and performed a Hepatico-jejunostomy

[@hassansidahmedmohamedosman1005]

@@ashwinthangavelu Thanks Sir.

[@jitendrajha9691]

Text you copy will automatically show hereRespected sir, 45 years old male with no comorbity admitted under Gastroenterolist with c/o upper abdominal pain associated with vomiting. Vitals are ok. His USG done outside shows acute cholecystitis with cholelithiasis with microcholedocholithiasis. LFT show bil 2.01, SGOT/PT 501/450 and ALP was 200. ERCP with CBD clearance without CBD stenting was done yesterday (21/04/2020). Now today i have been consulted for laparoscopic cholecystectomy. I advised LFT and s. Lipase. LFT today shows Bil 3.10 and ALP 250 with slightly elevated serum lipase (2 times) liver enzyme and USG show mild IHBR mildly dilated CBD with acute cholecystitis. Now have questions for expert 1. Should i perform laparoscopic cholecystectomy today or wait till LFT get normalised. 2. Should i wait and repeat LFT after few weeks. 3. Role of MRCP after ERCP (Gastroenterolist sure about CBD clearance) 4. Can acute cholecystitis per se raise serum bilirubin 3.10 without Mirzi?

[@ashwinthangavelu]

ERCP should always be combined with deploying of a stent. Amylase is more relevant now than lipase. Since the values have increased and there is IHBR dilatation ( microcholedocholithiasis will not cause IHBR generally ), I think there is an ongoing inflammatory process, so I would not intervene till that subsides. MRCP if the enzymes dont settle within a week with meds. Acute cholecystitis can per se raise the Bilirubin levels, similar to sepsis cascade. Pt if an alcoholic, could have had some baseline liver issues

[@jitendrajha9691]

This is what I have have advised today and postponed the surgery. If LFT get settled down within a week, should be wait for 4- 6 weeks as we usually plan as a interval cholecystectomy or do early cholecystectomy (here patient is post ERCP without Stent). Thanks a lot sir for your valuable opinion

[@ashwinthangavelu]

@@jitendrajha9691 You can do in a week, if he is Covid negative. Because there is no stent, possibility another attack is there if we wait longer

[@bertrandanicetmelimomene2337]

it was too big to be the cystic duct

[@ashwinthangavelu]

Yes that is correct

[@muhammadimran-ji1lz]

it is not mistake he is a bonga surgeon

[@ashwinthangavelu]

Agree it should have been avoided. In laparoscopy it is easy to lose your way and have tunneled vision. Can happen to anyone if not aware about the important landmarks to guide us

[@prashanthombal8394]

Too many red flags ignored...

[@ashwinthangavelu]

I agree that is the purpose of the video