Difficult Cholecystectomy for Acute Cholecystitis

[@doctor_sarvam]

Excellent the way you explained it sir.

[@ashwinthangavelu]

Thank you

[@sofiakh3614]

Bravo dr

[@ashwinthangavelu]

Thank you

[@aravindramkumar5956]

Thanks for the video Dr. In obese patients with acute cholecystitis, what is your strategy regarding timing of operation, extra left hypochondrium port for blade retractor etc?

[@ashwinthangavelu]

If the pt is medically fit, then we prefer early intervention within 5 days. If beyond that time or not fit, then optimise and plan after 6 weeks. I place the camera port supra umbilically so the Duodenum doesnt generally come in our field of view, additional port comes in handy for only this retraction. majority of the cases we can manage with standard 4 ports itself

[@OmarElfardy-jj2cm]

تسلم ايدك ❤❤❤❤

[@ashwinthangavelu]

Thank you for the feedback

[@mineshsindhal]

Very nice video sir👍

[@ashwinthangavelu]

Thank you

[@mondalrakesh1347]

Awesome sir ...upload some difficult appendectomy , appendicular lump and base perforation

[@ashwinthangavelu]

kzbin.info/www/bejne/anyun3tmlL52oKM

[@ashwinthangavelu]

kzbin.info/www/bejne/iKaxk4umg7V1os0

[@ashwinthangavelu]

kzbin.info/www/bejne/qWbPhZuDn8yLbdk

[@mondalrakesh1347]

Thank u sir ...after watching ur video I m getting much confidence..and am slowly taking up the difficult cases and following the steps exactly shown by u ..and getting good results too . Thank you so much sir from one of ur student

[@jitendrajha9691]

Nice demonstration sir. Did you place drain in this case?. When do you consider drain?

[@ashwinthangavelu]

Drain I place when there is a doubt about the fragility of cystic duct. CBD exploration and choledochoduodenostomy

[@TARIQWAHAB2]

do you put drain in such cases?

[@ashwinthangavelu]

¥es we do

[@mineshsindhal]

Sir what are the electrocautery setting you use for lap cholecystectomy?

[@ashwinthangavelu]

25 watts

[@tejadr]

Thanks for the videos and explanation of steps

[@ashwinthangavelu]

My pleasure

[@qaiserktk1]

Sir please upload a video of extracorporal suturing technique in lap surgeries.

[@ashwinthangavelu]

Ok will do soon

[@mineshsindhal]

Please tell me which video editor you use ?

[@ashwinthangavelu]

Final cut pro X in mac

[@Shailendrasingh-bk5kg]

IMPRESSION MR findings are suggestive of Cholelithiasis with chronic cholecystitis as described. Focal dilatation of extra-hepatic CBD is noted with distal smooth tapering - likely type Ib choledochal cyst. Gross hepatomegaly. Sir isme kya ho skta h operation se thik ho skta h

[@ashwinthangavelu]

Yes you will need surgery

[@TheAnalgesic]

Sir please upload video of fundus first lap cholecystectomy...

[@ashwinthangavelu]

Rarely only I have had to do fundus first, I keep it as the last option, because in fundus first the Liver will keep falling into the field and it will be difficult to retract it

[@OmarElfardy-jj2cm]

Acute G B ❤❤

[@ashwinthangavelu]

Yes

[@ashishchaudhary1229]

For an experience surgeon it is easy, otherwise these acute cases should be treated conservatively Surgery be done after 6 wks

[@ashwinthangavelu]

This pt was not responding to conservative management, hence not option of deferring

[@mbmii1778]

I would have sleepless nights not having attended to the cystic duct - but that me; maybe paranoid; not an easy one by a stretch; the easy of window before node was welcoming; respects though

[@ashwinthangavelu]

Thank you. Cystic duct was demonstrated at 5.40 and clipped at 6.30. Cystic artery could not be clipped and was coagulated alone.