CHO LE CYS TE CT O

MY
BY: HOPE
ALBURO
surgical removal of
the gallbladder, an
organ located just
under the liver on
the upper right
quadrant of the
 A Gallbladder is….
• small pear-shaped
organ which lies
on the underside
of the liver
• is connected by
ducts (or tubes)
with the liver and
with the upper
portion of the
small intestine
•a branch of the bile duct
which runs into the first
part of the intestines that
stores some of the bile
•contracts and forces bile
out into the duct leading
into the intestine
•when removed, this
function is taken over by
 The Reasons…..

•gallbladder contains
gallstones
(cholelithiasis)
•is inflamed
•infected
(cholecystitis)
 Types of
Cholecystectomy
OPEN
•4- to 6-inch incision in
the right upper portion
of the abdomen
•liver is lifted out of the
way and the
gallbladder is carefully
Laparoscopic
Method
• instead of making one large
incision, the surgeon makes
four
• one incision is made right
under the navel (umbilicus)
and a laparoscope is inserted
• the laparoscope is a miniature
telescope attached to a
camera, and through its lens
the surgeon can see the
• Instruments are inserted through
the other incisions
• The gallbladder is cut free and
pulled through one of the
incisions.
• Before removing it, the surgeon
sometimes shrinks the
gallbladder by suctioning out the
bile.
• Incisions are sutured or stapled
Nursing Responsibilities
 Before…
• Obtain informed consent. The role of
the nurse is to witness the signing of
the informed consent. It is the
nurse’s responsibility to reinforce
what is learned by the patient
• Reinforced to client and family the
surgical procedure to be done, how
long it will take, possible
complications and preventive
measures
• Health teachings done regarding
proper hygiene necessary for pre-
operative preparations like taking a
• Instruct that walking and limited
movement are generally encouraged
postoperatively, but strenuous activity
should be avoided.
• Inform the patient of signs and symptoms
that needs to be reported to the physician
immediately
– fever and/or chills
– redness, swelling, or bleeding or other
drainage from the incision site(s)
– increased pain around the incision
site(s)
– abdominal pain, cramping, or swelling
• NPO post midnight to allow time for
stomach to empty and decrease
aspiration
• Pre op medication to be given
• Operative records complete
 During…
• Assist patient to OR theater
• Remove prosthesis, jewelries, nail polish
etc.
• Valuables taken
• Assist patient in transferring to OR table
• Attachment of life- supportive devices and
indwelling catheter
• Induction of anesthesia
– assist patient in c-shape position
– skin preparation on posterior surface
using betadine paint
• Patient prepared for initial
intraoperative cholangiogram
• Skin preparation done on
operative site
• Medical and surgical
handwashing done by nurse
• Gowning and gloving by nurse
• Setting up of complete pack and
instrument set
• Initial counting of instruments,
Skin Preparation
• Gowning and gloving of physicians
• Offering of draw sheets, towels,
towel clips, lap sheet
• Offering of scalpel needed for initial
cutting
– physician makes an oblique right
subcortal incision, carried down to
peritoneum
• Offering of cautery cord and sponges
• Offering of US Army navy retractors,
tissue forcep without teeth and
sponges
• Richardson retractors, OS and visceral
packs
– physician continuously visualizes interior
portion
• Offering of series of Kelly curve forcep
– clipped on adjacent organs as well as to
reduce bleeding
• Offering of Scalpel and metzenbaum
• physician performs Kocher maneuver
( release of lateral and posterior
attachments of second portion of
duodenum
• physician palpates common bile duct,
• PNSS prepared for flushing and
suction cord to clear site
– site of removal identified and
skeletonized by physician
• Set of stick ties ,traction sutures and OS
prepared
• traction sutures placed laterally and
medially
• stick ties tied to ducts thus checking
for patency
• Metzenbaum offered
• physician continuously cuts
attachment site of gallbladder
• cystic ducts and arteries are ligated
 – Offering of bowl of PNSS
• irrigation done proximally and
distally to flush out excess clots
and stones present in common
bile ducts
– Suctioning cord offered for
suctioning
– Deaver with wooden handle
prepared
• physician continuously visualizes site in
preparation for insertion of t-tube
 – More stick ties and Kelly curve offered
• choledochotomy is closed around t-
tube
– Radiopaque contrast material dye
is prepared introduced in a French
5 catheter
– Follow up counting of
instruments,needles, ATR,
operating sponge, visceral packs
– Patient is prepared for another
cholangiography to confirm
presence of stones and leaks
 • Cautery and suction cord
prepared
• series of cauterization and
suctioning is done for clotting
• hemostasis done
• Offering of operating sponges and sponge
sticks to clear site
• Metzenbaum and Pott’s sciccors are
offered
– removal of gallbladder and stones done
– specimen out
• Suture prepared for repair of detachment
site
 – Counting of instrument, needles, ATR,
operating sponges, visceral packs
• Necessary sutures and mayo scissors are
prepared for layer by layer closure
– closure of peritoneum and rectus sheath
– continuous interlocking
– closure of anterior rectus sheath and
fascia – continuous interlocking
– closure of subcutaneous layer and
muscle
– skin closed subcuticularly
• Final counting of instruments, needles,
ATR, operating sponges, visceral packs
•Final counting of instruments,
needles, ATR, operating sponges,
visceral packs
•Final cleansing of surgical site
•Application of dry sterile dressing
 After…
•Removal of attached
assistive and operative
devices
•Patient is undraped
•Aftercare to be done in the
OR theater
•Patient transferred to post
anesthetic care unit
• Patient for NPO
• Monitor vital signs for 15 min.
for 2 hours then 30 min. for 2
hrs ; q hourly thereafter
• Monitor pain score q hourly
• Administer post-op
medications
• Monitor intake and output q
hourly
• Refer accordingly
TH ANK YOU AN D GOD
BL ES S!