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Laparoscopic Cholecystectomy

Ernesto Coianis MD, considered one of the best surgeons in Argentina presents his technique of Laparoscopic Cholecystectomy. Dr. Coianis received his medical degree from the University of Buenos Aires, School of Medicine in Argentina. He did his residency at the Santojanni Hospital where he became chief resident and later on Instructor. Dr. Coianis is well known for his unique surgical skills making any procedure appear effortless with impeccable opeartive field. He became the role model for many residents who adopted his technique as a gold standard for routine operations.

Grasping forceps are pushing up the fundus of the gallbladder elevating the liver and streching the gallbladder longitudinally. A second instrument holds the Hartmann's pouch allowing a good visualization

of the triangle of Calot.

This image shows a lateral retraction on the Hartmann's pouch, pulling the cystic duct and artery away from the hepatic duct. A disector is passed through to isolate the cystic duct from the artery.

Once the cystic artery is isolated and cleaned of its attachments the cystic duct is dissected and clearly visualized by puhing backwards the cystic artery and forward the duct in one single manouver. Laparoscopy.com takes the liberty to coin this move as "The Coianis' manouver".

Upon completition of the dissection, clips are applied to the cystic artery and divided with scissors.

Now the cystic duct is fisrt doubly clipped and then transected with scissors. Electrocautery or laser should not be used to avoid necrosis of tissue under the clips and possible post-operative bile leakage.

Dissection is performed through each side of the gallbladder dividing the peritoneal reflection. The hartmann's pouch is pulled superiorly and medially to permit good field exposure while the gallbladder is being freed from the liver bed.
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