Setup for a Laparoscopic Cholecystectomy (Ivy Tech Community College, Indianapolis, IN)

Laparoscopic cholecystectomy is the gold standard for gallbladder removal because it provides better outcomes for patients and quicker recovery time. This video offers one perspective on how to organize one’s back table and Mayo stand for this procedure. 

First performed in 1985, laparoscopic cholecystectomy revolutionized gallbladder surgery and is now the preferred approach worldwide.¹ This minimally invasive technique offers significant advantages over open cholecystectomy, including less postoperative pain, shorter hospital stays, faster recovery, and improved cosmetic results.^2–5 

All laparoscopic procedures require laparoscopic instruments. These differ from the surgical instrumentation used in open cases because they are designed to be inserted through small incisions via trocars. Proper organization and preparation are important for maintaining surgical flow, minimizing operative time, and ensuring patient safety. The operating room setup must accommodate both laparoscopic-specific and traditional surgical instrumentation, as conversion to open cholecystectomy occurs in approximately 2–15% of cases.^6,7

An efficient setup begins with organization of the laparoscopic equipment. The camera and camera cord, insufflation tubing, irrigation, and suction tubing are placed on the Mayo stand for easy access by surgical team members.

An electrocautery hook serves as the primary dissection instrument, allowing precise tissue separation and hemostasis. Maryland grasping forceps, designed for laparoscopic procedures, provide atraumatic grasping, which is essential for gallbladder manipulation. Two types of graspers are typically employed during this procedure: locking graspers are used to secure fundus retraction and non-locking graspers are used for tissue manipulation during dissection. Instrument selection depends on surgeon preference, procedural requirements, and patient anatomy.

Although laparoscopic procedures are considered minimally invasive and the conversion rate from laparoscopic to open is low, the surgical team must always have the appropriate traditional instrumentation available in the OR, should the need arise to convert to an open case. The standard surgical instrumentation for an open cholecystectomy includes retractors, hemostats, tissue forceps (toothed and non-toothed), scissors, and needle drivers. Instruments are grouped and organized according to surgical protocols.

Surgical counting procedures are a critical safety component of any surgery. The protocol includes systematic counting of all sponges, sharps (scalpels, electrocautery tips, sutures), and instruments. The initial count, performed before the procedure, establishes a baseline.

The Mayo stand is the primary instrument platform during a laparoscopic cholecystectomy and should be organized to optimize surgical flow. It makes sense to place items and instruments that will be used frequently during the procedure (sponges, graspers, electro-cautery, and so forth) onto the Mayo stand, which is wheeled close to the patient and is easily accessible by the surgeon. As the case proceeds, move the items that are no longer needed off the Mayo stand and return them to the back table. 

The protocol shown in this video highlights the essential role of surgical technologists in modern surgical care and provides an example of a safe and efficient back table and Mayo stand setup for a laparoscopic cholecystectomy.

This video/documentation was created for educational and training purposes. All individuals should always follow their facility’s established guidelines, policies, and protocols when performing any clinical or surgical tasks.

Please note that due to specific filming requirements and institutional requests, the surgical technologist featured was not wearing eye protection or a bouffant over her cloth cap. This deviation was made solely for filming visibility and should not be interpreted as acceptable practice. All personnel must adhere to proper personal protective equipment (PPE) protocols as outlined by their institution and governing regulatory bodies.

Additionally, individuals should maintain continuous awareness of sterile boundaries when handling instrumentation and working within the sterile field to ensure patient and personnel safety.