Cholecystectomy (Removal of the Gall Bladder)
Figure 1. (right)
The gall bladder has been placed in a specimen retrieval bag ready for aspiration of bile and subsequent retrieval from the abdomen.
“Rhepp”, a nine year old miniature schnauzer
“Rhepp” , a nine year old miniature schnauzer, presented to the minimally invasive surgery service after his owners had had some routine bloodwork performed which demonstrated some abnormalities in his liver bloodtests. After further investigation and an ultrasound scan he was found to have a developing biliary mucocele. This is a condition where thick sludgey bile builds up in the gall bladder over a period of time. “Rhepps” owners had monitored this build up over the previous two years until the point when his gall bladder was almost completely full of thick congealed bile. When this occurs there is a risk of two serious problems occurring. Either the bile can cause a blockage of the biliary tract or the gall bladder can burst spilling bile into the abdominal cavity. Either of these events can make a dog very sick and is associated with an approximate 20-40% mortality rate even if surgery is performed rapidly to remove the gall bladder. Rhepp’s owners decided to try and prevent either of these things from happening by having his gall bladder removed while he was still very healthy.
We decided to perform a laparoscopic cholecystectomy. This procedure involves making four very small incisions for the placement of ports into the abdomen. Through these ports the organs can be manipulated. In this case the gall bladder was dissected out and the cystic duct (the connection of the gallbladder to the rest of the biliary tract) was ligated using extracorporeally-tied laparoscopic slipknots. After the gall bladder was freed from the surrounding liver it was placed in a specimen retrieval bag (Figure 1). Once in this bag the bile inside the gall bladder was aspirated thus allowing the specimen to be removed through a much smaller incision that would normally be necessary. The traditional “open” approach necessitates removal of the gall bladder through a large abdominal incision. Rhepp recovered from this surgery very well and went home 48 hours after the operation.
Figure 2.
Postoperatively, only four very small incisions are seen where the ports were placed for the introduction of instruments. The slightly larger incision on midline is where the specimen was retrieved from.
Figure 3.
Rhepp at home happy and healthy three weeks post-operatively.