Latest Procedure Of Laparoscopic cholecystectomy

Procedure:

• To begin the operation, the patient is placed in the supine position on the operating table and anesthetized.

• Disinfect the skin of patient using antiseptic lotion like savlon,betadin,spirit.

• Maintain the sterile technique during procedure.

•  A scalpel is used to make a small incision at the umbilicus

•  Using either a Veress needle or Hasson technique the abdominal cavity is entered.

• The surgeon inflates the abdominal cavity with carbon dioxide to create a working space.

• The camera is placed through the umbilical port and the abdominal cavity is inspected.

• Additional ports are opened inferior to the ribs at the epigastric, midclavicular, and anterior axillary positions.

• The gallbladder fundus is identified, grasped, and retracted superiorly. 

• With a second grasper, the gallbladder infundibulum is retracted laterally to expose and open Calot's Triangle (the area bound by the cystic artery, cystic duct, and common hepatic duct). 

• The triangle is gently dissected to clear the peritoneal covering and obtain a view of the underlying structures.

• The cystic duct and the cystic artery are identified, clipped with tiny titanium clips and cut.

• Then the gallbladder is dissected away from the liver bed and removed through one of the ports

Recently, this procedure is performed through a single incision in the patient's umbilicus. This advanced technique is called Laparoendoscopic Single Site Surgery or "LESS".

Definition And Nursing Management Of Post Operative Care

Definition:

Post operative care is the management of a patient after surgery. This includes care given during the immediate post operative period in post anesthesia care unit (PACU), as well as during the days following surgery.

The goal of post operative care is to prevent complications such as infection, to promote healing of the surgical incision, and to return the patient to a state of health.

Nursing Management:

After the surgical procedure, and anesthesia reversal and extubation the patient is transferred to the PACU. The length of time the patient spends there depends on the length of surgery; the type of surgery; the status of regional anesthesia (for example, spinal anesthesia); and the patient's level of consciousness. Nursing management is most important for post operative patient.

• Keep the patient in comfort and safety position.
• Monitor vital signs including Blood pressure, Respiration, Pulse rate , and Temperature, 15mins for first hour, 30 mins for next 2hours, Then if stable 4 hourly during 24hrs and maintain record chart.
• Assess resp rate, oxygen saturation and administer supplemental oxygen as prescribed.
• Assess the surgical site and wound drainage systems.
• Assess level of consciousness, orientation and ability to move extremities. 
• Assess Intravenous sites for patency and infusions for correct rate and solution. 
• Maintain fluid input and output and fluid balance chart.
• Chaked Urinary catheter – position, patency, hourly urine output/volume, colour and concentration.
• Assess pain level, pain characteristics (locationand quality) and timing, type and route of administration of last pain medications.
• Administer analgesics as prescribed and assess their effectiveness in relieving pain
• The patient should be turned every two hours, and should at least be sitting on the edge of the bed by eight hours after surgery.
• Patients should be kept NPO (nothing by mouth) as ordered by the surgeon, at least until their cough and gag reflexeshave returned.
•  Body temperature must be monitored, since patients are often hypothermic after surgery and may need a warming blanket or warmed IV fluids.
• Patients often have a dry mouth following surgery, which can be relieved with oral sponges dipped in ice water or by applying lemon ginger in mouth swabs.
•  The patient should be encouraged to splint chest and abdominal incisions with a pillow to decrease the pain caused by coughing and moving.  
• Provide information to patient and family.