Laparoscopic Cholecystectomy Tutorial - page 4

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In cases where a cholangiogram is not felt to be necessary, multiple clips are placed on the cystic duct and the duct is divided. The laparoscopic clipping device is most commonly inserted via the subxiphoid cannula. This step should only be performed after the relevant anatomy has been established and the surgeon is comfortable with the size and appearance of the associated ducts. Two clips are placed on the staying side and a single clip placed on the specimen side, as close as possible to the gallbladder. Care must be taken not to impinge on the common bile duct with the two cystic duct clips. Once the cystic duct is clipped securely, it is divided between clips with an endo-scissor, leaving the two staying side clips behind.