Laparoscopic Cholecystectomy Operative Report Using Hassan Technique
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Symptomatic cholelithiasis
POSTOPERATIVE DIAGNOSIS: Symptomatic cholelithiasis
PROCEDURE: Laparoscopic cholecystectomy using Hassan technique for initial access
SURGEON: [Surgeon Name]
ASSISTANT: [Assistant Name]
ANESTHESIA: General endotracheal anesthesia
ESTIMATED BLOOD LOSS: Minimal
COMPLICATIONS: None
INDICATIONS FOR SURGERY
The patient underwent laparoscopic cholecystectomy as the first-line treatment for symptomatic gallstone disease, which is the gold standard approach with demonstrated lower complication rates and shorter hospital stays compared to open surgery. 1
OPERATIVE TECHNIQUE
Initial Access - Hassan Technique
- A small infraumbilical incision was made through the skin and subcutaneous tissue 2
- The anterior rectus sheath was identified and incised sharply under direct visualization 2
- The peritoneum was grasped with hemostats and opened under direct vision to establish controlled entry into the peritoneal cavity 2
- A blunt-tipped Hassan trocar (10-12mm) was inserted through this opening and secured with fascial sutures to prevent gas leakage 2
- Pneumoperitoneum was established using CO2 insufflation to a pressure of 12-15 mmHg through the Hassan port 2, 3
Port Placement
- After establishing pneumoperitoneum, three additional trocars were placed under direct laparoscopic visualization 2, 3:
- 5mm port in the epigastrium for the laparoscope camera
- 5mm port in the right midclavicular line below the costal margin for dissection instruments
- 5mm port in the right anterior axillary line for retraction 2
Gallbladder Dissection
- The patient was placed in reverse Trendelenburg position with left side down to optimize visualization 2
- A grasping retractor was placed on the fundus of the gallbladder and retracted cephalad over the liver edge 2
- A second grasper was placed on Hartmann's pouch and retracted laterally to provide countertraction for hilar dissection 2
Critical View of Safety Achievement
- The hepatocystic triangle was meticulously cleared of all fat and fibrous tissue using a combination of electrocautery and blunt dissection 4, 2
- The lower third of the gallbladder was dissected free from the liver bed 4
- Critical View of Safety was confirmed by visualizing only two structures (cystic duct and cystic artery) entering the gallbladder with no other tissue in the hepatocystic triangle 4
Cystic Duct and Artery Management
- After achieving Critical View of Safety, the cystic artery was carefully skeletonized and doubly clipped proximally and singly clipped distally, then divided 2
- The cystic duct was similarly skeletonized, doubly clipped proximally and singly clipped distally, then divided 2
- [Optional: Intraoperative cholangiography was performed through the cystic duct to confirm biliary anatomy before division] 2
Gallbladder Removal
- Retrograde dissection of the gallbladder from the liver bed was performed using electrocautery with careful attention to hemostasis 2
- The gallbladder was completely detached from the liver bed 2
- The liver bed was inspected for hemostasis and bile leakage 2
- The gallbladder was placed in an extraction bag and removed intact through the umbilical Hassan port 2
Closure
- The peritoneal cavity was irrigated and all fluid aspirated 2
- Final inspection confirmed no bleeding or bile leakage 2
- Pneumoperitoneum was released under direct visualization 2
- The Hassan port fascial defect was closed with absorbable suture 2
- All port sites were closed with subcuticular sutures 2
FINDINGS
- Gallbladder: [describe appearance - inflamed/non-inflamed, adhesions, etc.]
- Multiple gallstones identified
- No evidence of bile duct injury
- Liver appeared normal
SPECIMEN
- Gallbladder with stones sent to pathology
PATIENT DISPOSITION
- Patient tolerated the procedure well with no intraoperative complications 1
- Extubated in the operating room and transferred to recovery in stable condition 3
- Expected hospital stay less than 24 hours with early return to normal activity within 7 days 5
SAFETY CONSIDERATIONS APPLIED
- Hassan technique for initial access provided direct visualization and controlled entry, reducing risk of visceral or vascular injury 2
- Critical View of Safety was achieved before any structures were clipped or divided, which is the primary method to prevent bile duct injury 4
- The surgeon maintained readiness to convert to open procedure if Critical View of Safety could not be achieved or if complications arose 4