Laparoscopic Cholecystectomy

This morning, we had the fortunate opportunity to observe a laparoscopic cholecystectomy (removal of the gallbladder) performed by a highly experienced and educational physician. The doctor has been a general surgeon for 30 years and has performed laparoscopic procedures nearly exclusively for 20. He said he had performed between 10,000 and 15,000 laparoscopic procedures, and it showed once he began the surgery. I have observed other cholecystectomies at the Washington University School of Medicine, and this surgeon’s work was just as impressive even with significantly older and reusable equipment.

We prepped the OT and observed as the silent patient entered the room, lay down on the bed, and waited for what to him must have seemed like an eternity for the anesthesiologist to arrive. Most patients have a pulse around 150 as they await surgery here, but this man’s was a remarkable 68. To be honest, I would have felt in very good hands under this surgeon as well.

In no time at all, the anesthesiologist had the patient under general anesthesia and the surgeon arrived and was cutting 60 seconds later. Four small incisions (less than 2cm) were made in the navel, about 8cm above the navel, about 15cm right of the navel, and about 15cm up and right from the navel. The abdomen was inflated with CO2 for about 20 seconds and port mechanisms were inserted into the small holes through which an arsenal of tools could be inserted and removed as necessary. Then the surgeon started to really show his expertise. He slid in the scope through the navel and gave us a short tour of the organs. He then positioned the scope to watch as each tool broke through the peritoneum. With four tools now positioned next to the liver, he quickly maneuvered to and positioned the gallbladder. A tool came out as a syringe went in to drain the gallbladder of bile. The syringe came out and more tools went in. In an orchestra of both fine and sweeping movements, the gallbladder was clamped off from the rest of the body and cauterized away from the liver. The port above the navel was removed and the gallbladder was lifted through the remaining hole to the surface. The stone was too big to remove through the small incision, so the surgeon inserted a special tool into the gallbladder to crush the stone and easily extract the entire organ through the tiny incision.

The fluidity, cleanliness, and proficiency with which this procedure was performed was amazing to watch. In the United States, this procedure would cost thousands of dollars. For nearly the exact same outcome and same minimally invasive surgery, the cost here is about Rs 20,000–25,000 ($370-$470). Incredible!