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ABCD laparoscopic cholecystectomy in the morbidly obese patient

By Yan Mei Goh

With the advent of the obesity endemic, surgeons would more frequently encounter obese patients and its challenges when performing a laparoscopic cholecystectomy. Some guidelines suggest that obesity alone is not an indication for conversion to open cholecystectomy.
Laparoscopic cholecystectomy in the morbidly obese patient pose different difficulties at each stage of the operation. These challenges and difficulties encountered can be overcome by developing a standardised approach to LC in this group of patients. It provides a framework for surgical trainees to identify and address challenges posed by this group of patients methodically to allowing this procedure to be completed laparoscopically whilst minimizing the risk of bile duct injury, and reducing the rates of conversion to open.

Four aspects of laparoscopic cholecystectomy have been identified and standardized to enhance safety.

  1. Safe induction of pneumoperitoneum.
  2. Enhancing intra-operative view.
  3. Visualisation of Calot’s triangle.
  4. Retrieval of the gallbladder.

This app approaches each of these challenges systematically and provides methods of overcoming these difficulties.

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