Robotic cholecystectomy - AP

The patient was met in the preoperative holding area all questions were answered and consent was confirmed. The patient was transported to the operating room placed on the OR table, bony areas padded, sequential compression devices applied to the bilateral lower legs, secured with straps and beanbag. General anesthesia was induced and the patient was intubated without issue. The abdomen was prepped and draped in normal sterile fashion. Preoperative Ancef was given prior to incision. A timeout was done and all were in agreement.

The abdomen was insufflated via Veress needle in the [location] to 8 mmHg. Left upper quadrant optical trocar entry was then done with an 8 mm robotic port. There was no visceral injury noted on this entry or the Veress needle. The remainder of the two 8 mm robotic ports were placed to triangulate the gallbladder. A right lateral 5 mm port was placed for retraction. The robot was docked, and we took place on the console. The gallbladder was inspected and there were noted to be [adhesions]. The gallbladder was noted to be [inflamed, non-inflamed], and was drained with a laparoscopic decompressive needle.

I dissected the triangle of Calot, isolating the cystic duct and cystic artery, dissecting the lower one third of the cystic plate off of the liver bed. The hepatocystic triangle was fully cleared of fibrofatty tissue and the critical view of safety was confirmed prior to any clipping or cutting. A timeout was done noting only two structures going through the hepatocystic triangle towards the gallbladder, the triangle free of fibrofatty tissue and the lower one third of the gallbladder dissected off the fossa confirming the critical view of safety. The cystic duct was clipped in triplicate, and a single clip was placed on the artery. The duct was transected with cut electrocautery on the hook. The artery was transected with coagulation electrocautery. The gallbladder was freed from the fossa with hook cautery. It was extracted in a bag. Hemostasis was achieved and confirmed to the liver bed with electrocautery.

The camera port was placed to the right of midline, and the fascia did not need to be dilated to extract the gallbladder therefore there was no indication to close the fascia. All skin incisions were closed with running 4-0 Vicryl and Steri-Strips. [volume] cc of local anesthetic was injected throughout all incisions as a local field block. Final counts were correct. The patient was liberated from anesthesia extubated and transported to the PACU in stable condition.

Dr. [attending] was present for the entire case.