OR Setup for a Laparoscopic Cholecystectomy (South College, Knoxville, TN)

The laparoscopic approach is widely regarded as the preferred surgical method for gallbladder removal procedures. The operating room setup for laparoscopic cholecystectomy follows established protocols that provide patient safety through the use of aseptic technique and AORN guidelines for surgical counts. These procedures form the foundation for successful surgery and are covered in this article.

Since its introduction in the late 1980s, the laparoscopic cholecystectomy has become the preferred gallbladder removal procedure because it offers improved outcomes with fewer complications, faster recovery, and better aesthetic results.^1–6 All laparoscopic procedures require the use of advanced optical systems and laparoscopic surgical instruments.

The instrument table is divided into three sections: saline for irrigation, medications, and sharp instruments are placed at the working end of the table, closest to the patient; instrument trays are placed in the middle; drapes, gowns, and gloves are kept at the non-working end.

Essential surgical instruments for this procedure include trocars, high-definition cameras, light cords, fog-prevention cleaning tools, electrocautery, and laparoscopic instruments for grasping and dissecting. After the surgeon insufflates the abdomen, the gallbladder fundus is secured with atraumatic graspers; Maryland dissectors are used for cystohepatic triangle dissection, along with an electrocautery device. The cystic artery and duct are secured with laparoscopic clips and endoscopic loops to maintain hemostasis. A retrieval bag is used for extraction of the gallbladder in order to avoid perforation or bile leakage.

Surgical counts are performed to reduce the risk of retained surgical items within the patient. Some facilities count individual trocar components, as they can be disassembled into separate parts. This video covers preparation for the initial count, including a demonstration of how to count so the circulating nurse can see each item.

Before accepting medication or fluids onto the sterile field, the surgical technologist must verify the name, dosage/strength, and expiration date of each item with a licensed professional (nurse or doctor). Each container or syringe must then be labeled with the name of the medication or fluid, its strength/dosage, and expiration date. Should contrast dye be used for a cholangiogram, air bubbles must be removed because they can produce a false positive result that mimic choledocholithiasis.⁷

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.