Cholecystectomy

Gallbladder Removal

A cholecystectomy is a surgical procedure to remove your gallbladder — a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects, concentrates, and stores approximately 3-5 cups of bile daily — a digestive fluid composed of salts, enzymes, bilirubin, cholesterol, and other substances, produced in your liver, and released into the small intestines via the gallbladder.

Bile helps to break down fats into fatty acids for absorption during small intestinal digestion. Via several ducts, the gallbladder is also connected to the Pancreas, Liver, and Small Intestines. It is in these ducts that gallstones, if formed in the gallbladder, can leave the gallbladder and get trapped, blocking the flow of bile through the ducts. This common reason for a cholecystectomy causes severe pain and swelling of the gallbladder or the other surrounding organs. Gallstones are hardened digestive fluids that can form in the gallbladder, from the size of a grain of rice to as big as a golf ball. Gallstones and the associated inflammation in the gallbladder, liver, pancreas, or ducts can happen suddenly (acute) or over a longer period (chronic). Other gallbladder issues such as a tumor, duct dysfunction, or defects in the gallbladder organ itself may necessitate a cholecystectomy.

Dr. David W. Ford may recommend a cholecystectomy if you have:

  • A Gallbladder mass, benign or cancerous
  • Perforated Gallbladder or other organ damage/defects
  • Biliary dyskinesia, or when the gallbladder does not empty bile correctly into ducts
  • Gallstones in the gallbladder (cholelithiasis)
  • Gallstones in the bile duct (choledocholithiasis)
  • Gallbladder inflammation (cholecystitis)
  • Large gallbladder polyps
  • Pancreas inflammation (pancreatitis) due to gallstones in the common bile duct or pancreatic duct
  • Chronic or Acute Biliary Colic, or the severe pain in the abdomen caused by spasm or blockage of the cystic or bile duct
Ventral Hernia Diagram

Causes of Gallstones & Gallbladder problems

Most adults with gallstones do not have symptoms. Eighty percent (80%) of people with gallstones go 20 years without symptoms.

Gallstones are often the cause of gallbladder problems, but what causes gallstones? There are many factors or combinations of factors that can contribute to gallstone formation, specific to each individual. You are more likely to get gallstones if you:

  • Have a family history of gallstones,
  • Are Native American,
  • Are a woman,
  • Have had children,
  • Are overweight
  • Have lost weight rapidly,
  • Have sickle cell disease,
  • Have used estrogen to manage menopause,
  • Are over 40.

Doctors do not have a consistent way of preventing gallstones, however, a healthy lifestyle is always recommended as a standard to prevent or reduce conditions in combination with other surgical and non-surgical treatments. This includes a healthy monitored weight loss, daily exercise, and eating high-fiber foods such as beans, whole grains, peas, figs, apricots, dates, raspberries, blackberries, strawberries, corn, broccoli, plums, pears, apples, greens, and nuts.

Symptoms of Gallstone & Gallbladder problems

Gallbladder problems may cause pain occurring usually on the right side or middle of your upper belly, and can last from 30 minutes to 24 hours. This pain, also known as Biliary Colic, may be constant or may get worse after a heavy meal, or it may sometimes feel more like fullness than pain. The location of the pain may be felt in your back and the tip of your right shoulder blade. Acute Cholecystitis pain lasts longer than 6 hours, with abdominal tenderness and fever.

Other symptoms in addition to the sharp pain in your abdomen may include:

  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Indigestion
  • Jaundice or Yellow Skin
Anatomy of Gallstones
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Gallbladder Removal Treatment

Treatment of gallbladder problems and gallstones begin with an evaluation from Dr. David W. Ford using an Ultrasound test and exam, to confirm gallbladder issues or gallstones and eliminate the possibility of ulcers, liver problems and heart conditions that could contribute to pain.

If additional tests are required, a combination of one or more of the following examinations may be ordered by Dr. Ford:

  • Blood tests, including complete blood count,
  • Liver function tests,
  • Coagulation profile,
  • Abdominal ultrasound or Endoscopic ultrasonography,
  • a computed tomography (CT or CAT) scan,
  • Hepatobiliary iminodiacetic acid scan (called a HIDA scan) that uses a dye to show gallbladder and bile duct function,
  • Endoscopic retrograde cholangiopancreatography (ERCP), or a
  • Magnetic resonance cholangiopancreatography (MRCP).

If gallstones or other gallbladder problems show significant impediment to a healthy lifestyle, Dr. David W. Ford may recommend a surgical treatment using either Open surgery or the da Vinci Robotically assisted Surgical System. This may include an Endoscopic retrieval of the stones or a Cholecystectomy, a removal of your gallbladder. The cholecystectomy, along with intravenous (IV) fluids and pain medication is the standard treatment of acute cholecystitis.

A cholecystectomy can relieve the pain and discomfort of gallstones. Conservative treatments, such as dietary modifications, usually can't stop gallstones from recurring, however it is common for a cholecystectomy to prevent gallstones from coming back. A cholecystectomy is a common surgery, and it carries only a small risk of complications. In most cases, you can go home the same day of your cholecystectomy.

Cholecystectomies are most commonly performed using laparoscopic or robotically assisted laparoscopic surgical systems. In more complicated cases, one large incision is necessary to remove the gallbladder. This is called an open cholecystectomy. Dr. David W. Ford uses both open and the da Vinci Robotic Surgical System depending on the needs of his patients. In some cases, Dr. David W. Ford will begin with the da Vinci surgical system and find it necessary to make a larger incision because of scar tissue from previous operations or other complications in the gallbladder itself, bleeding problems or severe obesity. Both surgical methods, open and the da Vinci robotically assisted laparoscopy will require general anesthesia and may require a specialized X-ray of your gallbladder and bile duct during surgery. This X-ray can find gallstones in the common bile duct. If found, Dr. David W. Ford may need to do additional procedures during the surgery, or you might need another procedure to remove them later.

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Two types of surgical approaches to a cholecystectomy:

Dr. David W. Ford always approaches cholecystectomies with robotic laprscopic surgery. However, sometimes it may be necessary to utilize open surgery.

Robotically-Assisted Cholecystectomy with
The Da Vinci® Robotic Surgical System

Surgical robotics for minimally invasive surgery

The da Vinci Surgical System allows Dr. David W. Ford to perform minimally invasive Cholecystectomies with clinically supported precision and accuracy. During the robotically assisted cholecystectomy, Dr. David W. Ford makes four small ports or incisions, each less than 1 inch long, in your abdomen. A laparoscope (a tube with a tiny video camera) is inserted into your abdomen through one of the incisions.

Dr. David W. Ford who is seated in the operating room, operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and the camera. The images gathered from the laparoscope’s camera are high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the gallbladder removal. If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow Dr. Ford to view the inside of the body. After the gallbladder is removed, your incisions are sutured, glued or surgically clipped, and you're taken to a recovery area. A cholecystectomy using the da Vinci robotically assisted surgical system takes one or two hours.

There are many robotically-assisted surgical systems that are FDA approved and in use today. However, many are specially designed for specific organs, procedures or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in cholecystectomies. Dr. David W. Ford is not only an expert board certified surgeon, but also certified in the use of this leading-edge technology.

This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, the gallbladder removal can be done with more precision, and complex situations can be fixed with small incisions. Furthermore, the robot doesn’t get tired and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain and less complications.

Other benefits of robotic cholecystectomies include:

  • Access to clear three-dimensional images (unlike laparoscopic surgery’s two-dimensional images) of the inside of the abdomen for more precise surgery.
  • Dr. Ford can easily use stitches to sew tissue on the inside of the abdomen.
  • The patient is left with tiny scars rather than one large incision scar.
  • The possibility of much less pain, faster recovery and quicker return to normal diet and activities after surgery are observed, compared to all other types of gallbladder surgery.

In 2000, Intuitive’s da Vinci Surgical System was the first robotic surgery device to gain FDA clearance for use in general laparoscopic surgeries, including minimally invasive cardiac, colorectal, gynecology, head and neck, thoracic, urology, and general surgeries. Over 1,700 da Vinci Systems are currently installed in hospitals internationally, and more than 775,000 patients have received procedures from this robotic surgical system. With roughly 75 percent of all prostate cancer operations in the U.S. being performed using da Vinci devices, this robotic platform has established itself as an effective and reliable tool.

Should the robotically assisted surgical laparoscopic surgery be recommended as part of treatment for your gallbladder and/or cholecystectomy, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.

How The Da Vinci® Robotic Surgical System works

Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.

Surgeon Console

Surgeon Console

The surgeon console is where I sit during the procedure, have a crystal-clear 3DHD view of your anatomy, and controls the robotic instruments. Through a few small incisions, the tiny instruments are "wristed" and move like a human hand, but with a far greater range of motion.
Patient Cart

Patient Cart

The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.

A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.

Vision Cart

Vision Cart

The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.

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Robotic-Assisted Surgery

"The da Vinci Surgical System allows me to make smaller incisions, resulting in reduced risk of infection, minimize scarring, reduce pain, and accelerate recovery time, allowing my patients to return to normal activities more quickly."
David W. Ford, MD, FACS
da Vinci Surgical System
Traditional (Open) Cholecystectomy

Traditional (Open) Cholecystectomy:

During an open cholecystectomy, Dr. David W. Ford makes a 4-7-inch (approximately 15-centimeter) incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder, and ducts are clamped off. Dr. Ford then removes the gallbladder, and the incision is sutured or stapled closed, and you're taken to a recovery area. If necessary, a drain may be placed at the incision site. An open cholecystectomy takes one or two hours. Expect to spend two or three days in the hospital recovering. Once at home, it may take four to six weeks to fully recover.

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Post-operative Treatment of Cholecystectomies

People are often able to go home the same day as their surgery, though sometimes a one-night stay in the hospital is needed. In general, you can expect to go home once you are able to eat and drink without pain and are able to walk unaided. It takes about a week to fully recover.

As follow up, the gallbladder is sent to various labs for several tests, depending on the situation or severity, and you yourself may undergo additional imaging tests, such as an X-ray or ultrasound if Dr. Ford is concerned about possible gallstones in other areas, or other problems in your bile duct.

You may also have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing.

 

When to Contact Your Surgeon Post Operation

  • Pain that will not go away
  • Pain that gets worse
  • A fever of more than 101℉ or 38.3℃
  • Continuous vomitting
  • Swelling, redness, bleeding, or bad-smelling drainage from your wound site
  • Strong or continuous abdominal pain or swelling of your abdomen
  • No bowel movement 2 - 3 days after your operation

Prescription Refill Hours:
Monday – Thursday 8:30 AM – 4:30 PM
Friday before 2:00 PM

Pain

Pain management efforts are more successful if you take the medication as soon as you start to feel uncomfortable, rather than waiting until the pain is severe. Should you require a refill, please plan ahead, as we do not call in prescriptions after hours. Scheduled medication, such as narcotics, cannot be called in and must be written in-person.
Acetaminophen (Tylenol)
  • 650mg to 1000mg every 6 – 8 hours for first 3 days, scheduled
  • After 3 days, may continue as needed for pain
  • Do not exceed 4000mg in 24 hours
  • Avoid if history of hepatic (liver) impairment, alcohol abuse
Non-Steroidal Anti-Inflammatories (NSAIDs), choose one:
  • Ibuprofen (Advil, Motrin) 400mg by mouth every 6 – 8 hours, as needed
  • Naproxen (Aleve) 440mg by mouth every 12 hours, as needed. Avoid if history of renal (kidney) impairment, or a history of coronary artery disease (CAD), hypertension. Avoid multiple NSAIDs at once (e.g. Ibuprofen + Naproxen)
Narcotics and Opioids
  • Oxycodone, Hydrocodone & combo pills are for severe breakthrough pain ONLY
  • If a combo pill (e.g. Percocet, Lortab, Vicodin, Norco), do NOT take with Tylenol.
  • Do not drive or operate machinery while taking narcotic pain medication.
  • Narcotics can be habit-forming, have addiction potential, and cause constipation, so be careful – and use sparingly.
Tramadol
  • Tramadol (Ultram) is for severe breakthrough pain & often used in place of opioids
  • It is not a true narcotic but can be habit-forming with long-term use.
  • Avoid if history of seizures
Simethicone
  • Simethicone (GasX) 40 to 125 mg every 8 hours as needed for gas pain & bloating
  • Do not exceed 500mg in 24 hours; this is sold over-the-counter

Hygiene

  • You may shower and use soap and water on surgical site incisions, the day after surgery
  • Keep dressing clean and dry for 24 hours, you may replace as needed for drainage
  • Do not swim or soak; no hot tub, pool, beach, lake, etc. for at least 7 days

Constipation

  • Post-operatively & within 2 days, should be having regular, soft bowel movements (BMs)
  • Hydrate & drink plenty of water (8 –10 glasses per day)
  • PEG 3350 (Miralax) 17g by mouth each day for BMs each day

Other alternative recommendations, as needed – Use at least one if have not had a BM for 2 days:

  • Magnesium Hydroxide (Milk of Magnesia) 15 – 30 mL by mouth once a day, as needed
  • Magnesium Citrate 200 – 300 mL by mouth once a day, as needed
  • Docusate (Colace) 100mg by mouth twice a day, as needed

Activity

  • Ambulate and increase activity as tolerated post-operatively
  • Simply walking often improves mentation, decreases pain & bloating, and improves BMs
  • Avoid heavy lifting (greater than 20 pounds) until follow-up after laparoscopic and open surgeries
  • Avoid prolonged straining and strenuous activity until follow-up
  • Wear your abdominal binder after hernia repair
  • Resume all home medication as directed

Wound Care

  • The raised, firm area called a healing ridge is normal, and should resolve over time
  • Remove your dressings/bandages 2 days after surgery, unless told otherwise by Dr. Ford himself
  • You may shower and use soap & water on surgical site incisions, the day after surgery