Chapters Transcript Video Gallbladder and Extrahepatic Biliary System Presented by: Dr. Caroline T Massangalawe go blood and the extra robotic barrier system. Press the start of the anatomy. So the go back and the robotic uh beer system begins at the higher upgrade and ends at the employer of data. It includes the gallbladder and the extra robotic bell that. Mhm. So. Mhm. Uh basically there's uh it starts uh it starts with the right robotic dat and they left hepatic duct which joins through from the common robotic a body that and which we wish. Yeah which uh the two uh joins each other from the the the company have added that and then the insisted that from the cold blooded joined to form the common bile that which ends and took into the temple of murder. Well it's entering the your dinner. Mhm. And uh commonwealth that it's uh divided into four past uh with little difference difference point being the Georgina Georgina bob. Ah We have this soap opera retro and if infra and intra jordana paths the superjet you know tax together with the body gathering and they brought over from the photo bodies at the foramen of Winslow. And this area is important because during surgery, when the local methods of trying to control bleeding is not possible. Uh You can do a pringle maneuver whereby you clamp the that this area to stop the bleeding from there. Photo pain and the robotic other um They come on about that and the pancreatic that comes together at the media of they didn't have before me a sack like enlargement got the envelope for the body. This opening to the Georgian and popular uh uh drainage of uh cranberry juice and bio is controlled by this center. Odd at this area. Okay. Now the idea of supply of the common bile duct, the cystic artery supplies from a small part of the common bile duct and the right body gathering surprised in the middle. But why are the mysterious video? Thank you for your general theory and the gastro Georgina ordering supplies the store but the venous drainage. Mm hmm. Uh The drugs, no part of it uh events from their address directly into the river. And this is the part of it dress. It's drained by the co ceo superior of thank you for your dinner events. Lymphatic flow from the common bile duct. The cystic cliff notes. And they go brother nick. And they have not systematic pro throws from the common bile duct. The cystic leave notes go blood, the neck, robotic notes and the notes of the following. A very oh uh strategically important about idea supply of. Uh huh. The common byproduct is that the blood the blood versus usually lungs with the other aspect. So when doing an extensive, extensive this section or social investment, there's a list of uh disparate de vascular lies in the blood basis. And this can lead into ischemia. Come now they're not gonna go bladder. Uh it's a pear shaped organ about 7-10 cm long. No, my whole 30-60 minutes of bio. And its function is to concentrate bio. It is regarded on the fourth of the you for your service of believer uh discovered by the same peritoneum that covers deliver except we are is embedded in the liver. Um It is divided into four regions. The fungus boarding if you do them and make it's black. Supply is uh cystic artery which is a branch of right a bodyguard. Um Another important area is the curry triangle triangle which usually contains the carriage at the assisted. Other. Its borders are made by the superior is made by the inferior gonna deliver and lateral is formed by the cystic dat. And uh and media is formed by the come on, come on everybody that um This area is important because usually when someone is doing surgery you have to make sure that you identify this area to avoid uh like getting the stick Adderley. Histological e. Is composed of Nigeria and the connective tissues has abandoned elastic fibers and there's a layer of smooth muscles. Another important aspect of piano is that there are some variations that will cast in some people innovation to go blood and the the other extra robotic dance. Ah It is not in that 1/3 of the One thing. Only 1/3 of the population. As a classical description of the extra robotics assisting. Uh Sometimes they as I said, the goblin is extra robotic but in some people it can be found that it is intra hepatic and this can lead into formation of boston's um on the and some people are born with congenital uh oh my God, accessory that uh this puts them at risk of uh barrick if it's not recognized during a policy spectrum me and also about uh 50-60% of individuals have no more billiard death. Another me but some might have a parent or accessory. Um That's and usually they appear in the carotid triangle and also married into uh Angel is doing a paradigm if they're not doing an operation, if they're not, I didn't fight as well as some people might have. Yeah some people might have but they are assisting gallery from right from that. Mhm. Some people might have a replaced right here, body gathering and because of this brooks no uh approximately the cystic that in my ideas of people want to injure is doing uh an operation. Um As I say the biggest the the liver produces bile which is concentrated which is going to get it which is uh which is the liver produces bile which uh installed in the in the gallbladder there it is, what is absorbed and mucus is adding in and then the how it goes to the your dinner and there are certain factors that helps to control how this bow is delivered into the uh Jordan um Usually the it is controlled by the new genetic and hormonal influences. These are some of the homeless that helps in releasing of bio into the mhm Georgina. Uh, 90% of the Bible I think is really absorbed in the terminal medium. And viruses are conjugated by God, by God, bacteria. It is transported back to the police regulation back to the river born to Abdomen and 5% of it is excreted in thesis. So, critical evaluation where someone has got a problem with the with the extra extra dramatic video system, you can do a full blood count just to check if there's any sign of infection or information. You can do a liver function tests. Um mm on imaging, ultrasound scanning. Uh is the Number one is the first choice for imaging Because more than 90% of the questions are androgenic. If about that is David. If a bill that is delighted more than 10, it's an indicative of an obstruction. Uh most of course by the costumes and the recruit do your dino portion of their coming about that. Uh this is very important because this area, it's difficult to visualize using a another sons can another imaging that you can do is the hider. Uh Usually it involves uh uh injecting an intravenous uh compound. And and then you wait to visual you you try to visualize it in the gall bladder using a stand. If it takes more than two to us to see the they die. It means it's an indication that there is uh an obstruction. Uh and these findings are more sensitive than the other sounds. Uh Other son scanning for Douglas to Douglas and acute across the status. You can also do a ct scan of course. Although it's not very sensitive for death for ghost on disease but it's baseball uh identifying video trees and adjusting pictures. Especially in someone that you're suspecting that they might have a malignancy. You can do an M. R. I. Or what? M. R. C. P. Or endoscopic ultrasound. Endoscopic ultrasound. Okay? You can also do a victorious prince trans robotic uh angiography whereby you can access uh um Yeah but again access to the robotic bell that through the abdominal wall. And once the Bh three has been accessed, contrast can be put in can be injected in and you can use this to diagnose a disease. Or you can use this to drain or treat to drain uh a drink and be left in. You can use this as well. As for treatment purpose we're gonna put a drain to drain whatever you think is obstructing the patient. Another one is the E. r. c. p. Which involves viewing uh visual isn't the yeah it involves them. Um Okay it involves visualizing that the uh the biliary, the beer, the common bell that uh through the major Jordan of Evita. And you can use this as well for uh diagnosis as well as for as as a way of treating the patient if you're suspecting that they could cost on now on the this is the costumes. They are not common in africa though. Now it seems like the prevalence is getting higher. The way the gospels come about is if there is a mbas between the composition of the uh oh it can be classified into uh they can be classified classified as cholesterol or pigmented stone. And some they can be mixed the grocery store and uh It means that they are even 70% made with terrestrial and the usual. Yeah. But sometimes they can be green or or black and usually they are formed in various shapes. Pigmented pigments stones. They're usually made of uh custom be Reuben billy Rubin eight And they have two kinds black and he brown uh the black ones are usually singing. Um mm hmm. I'm already places and that usually almost formed in the gold blood. The blonde ones are small and the injury is not gonna do that to you. Or parasitic infections. Mhm mm hmm. 80% of ghosts and patients are symptomatic and the symptomatic ones they usually present with uh colleague pain. We fight we fight was video colleague. Now I've already been a vicious that can be done in ghost on disease. You can have policies custom e which means uh drainage of the gallbladder or or policy spectrum me whereby its removal of the bladder or procedures to evaluate here in the sun from the common bile that that yeah uh concept um is good for patients who questions who uh who have acute for societies and who are not. You are insurgents. And this can be performed under local anesthesia uh and consist ectomy can be done uh la paz copy carry or it can be done uh Logan surgery of note. Is that laparoscopic hysterectomy as highlight of common belt that injury. And therefore you should not be performed by a surgeon who is very skilled on this procedure. You can also do interpretive job from which is useful and agreed in the direction of Goldstone in the common belt. That or when we suspect that there's a bell engine. Not that I enjoyed ah throughout about that injury. And I will see my show the right and left like that common hepatic duct uh cystic cystic duct and become common bell data. This was the flow of contrast into the duodenum. You can also do a common about that experience exploration. And this is indicated in patients who have a common bus and about uh detected pre operatively or where E. R. C. P. Is available or in 66 weeks or after during inter operative by the angiogram. Yeah. Uh This can be done uh whether transit cystic or incision medal then comment about that. And the decision to do this depends on the uh all about that parameter as well as a number of stones that have been identified and decides as well about that engine. This is the most feared congregations of policy aspect. To me. It is very common in higher with laparoscopic equality spectrum. These factors include acute or chronic in from information, obesity. Another liberation bleeding. Virgin inexperience. Mhm. In a good exposure and failure to adequately identify structures before like getting our and dividing. Yeah. So what's gonna person do? Okay. But uh other Bennett diseases of the robotic uh extra robotic, you're assisting. You can have a regular school studies which is an information of the gallbladder without stone causing obstruction on there on the system that this is usually seen in very sick patients who are found in ICU and symptoms are similar to those ones of someone who uh calculus. Good societies. Um, phenomenal city is done is to create whether sounds can when it comes to this condition in uh recognizing uh, this condition, you can have got better negro cells which occurs due to longstanding obstruction on the neck of the gold blood. Uh, what happens is that the governor continues to produce mucus despite a sort being observed and they go brother will be filled with clear fluid for McCoy. And the treatment is called the spectrum. You can also have video exists which can be uh yeah. Uh when you need to see a delegation of the robotic robotic or into a body works to robotic Beatrice couldn't calling for the diagnosis there for men and females and there if you find them, you need to um Excites them because they are associated with Poland Poland Julia carcinoma. About 15% of them cannot be counselors. They are also five types Uh 54 now it's got carry disease which um yeah another burnin condition is still rising cholangitis. This is the result of uh repetitive information of starting and and restructuring octaves um extract of the woman about that. You can also have beer his pictures now. God magnus breathing conditions. Either way they tend to be very aggressive who are prognosis outcome go bladder cancer a common represent late and in the disease process because they associated the reason why the president really suppose they're associated with few symptoms and mostly originating the funding. They all the original from the founders of the body and first of most of the most of the other cancers are bogus numbers. They're harassed in people who have gone with a history of costumes. You can diagnose it by using to another some scanning city M. R. C. P. Or E. R. C. P. Teach company confirmation with bio section be performed To my ca c. 8 19 and it can be used to uh track current hope is just uh or persistence of the disease but cannot be used to diagnose. Um patients with the sector made a study have no survival benefits to key material and patients of johnny's and beer obstruction. Maybe benefit from sending and trans robotic drainage catheter. But still the survival. It it's a law and in the area? State stages are such as the only curative treatment available. This is the staging and I'm not going to discuss the second common uh really it's like magic be a system is cool and yoga's norma which is kind of the bio duck experience. Its shares many features as the go bloody cancer. There's a very poor prognosis and surgery is the only option of treatment. Risk practice includes as best oh and smoking. Um And I've noticed that near Oakland, yo customers are I didn't know that's normal staging paris on whether they are going to be as normal as any higher or this too. The usual representive sense and symptoms of obstruction. And when the Germans didn't fight on the imaging, there is no need to obtain, obtain a tissue for diagnosis. This dog and yoga stomach can be treated with people's tumor or but still with restriction. The survival rate about 50% approximately. And cool. And yoga cinemas are treated with the reception of the byproduct including consist spectrum and hemorrhagic tissue necessary to achieve uh negative market with the regional uh for the next to me because section involves worldwide A part of a particle indigenous to me. And with this still the survival rate of five years is less than 50 un respectable or metastatic disease should be treatment should focus on variation. Okay. Thank you. That's why I had. Mhm. Mhm. Is that mm. All right. Hello. Thank you so much. Yes. Welcome. So that's what I prepared. And I don't know if you have something to add to that. Me and my colleagues, we can learn more dr s Lynn your own needs. Yeah, Caroline. This is Marcus one. Thanks for doing that. Thanks for inviting us. Um that was good. That was very good. Uh The only thing I can say is that no your anatomy and the compatibility area area. Uh Because you're one telling slide is only a third of the people have normal anatomy coats. And you'll see all sorts of strange things over your career. Whether it's the hepatic artery coming off unusual places, the or the biliary system. And that's where you can get in trouble. And if you don't know the anatomy, take your time. Um The left to paddock artery can come off the celiac artery directly. And there's just lot of an atomic variations tom mama. And uh as far as cancers always have that in the back of your mind to whenever you see, you know biliary disease. So, but if you have any questions for me to be glad to answer it. Uh Otherwise very good. Thank you. Thank you. Yeah. I don't know if my my my colleague have got patients as well. Do you have questions traditions? So I just wanted to make a slight uh comment about the carloads triangle. Um You had said that uh for the colored strangle or the concern is about or you need to know you're not really in the triangle to avoid injuring the cystic artery. Um Anyway it might have just been a a mistake as you spoke. But anyway the main concern is about injuring the common hepatic duct and the right um Hepatic artery. So that's why you need to know the anatomy. The new carloads triangle so that you don't end up injuring the C. B. D. Well are getting the CBD instead of like getting the cystic duct and its artery. So that's the only comments that I wanted to make. Not. Do you have a laparoscopic? I have comments. I'll ask a question and make a comment. Do you have a laparoscopy available yet at queens? Um In the complication rate from laproscopic surgery now is going down and I'd say it's pretty comparable now to open um uh In terms of bio duct injury and artery injury. Um The systemic complications are much less in terms of respiratory and cardiac stress and recovery time and postoperative pain? I told uh and then the question I have is how often or when do you think you would use a collie cyst Ostuni? Um For the time being we don't do a laparoscopy on the other question. I think maybe it took back home but can come in. Um So we really do that now. I have only seen it being done once and that was when I was just starting. So it was at night and the patient that presented with an acute abdomen and we had found that the gold blood, I was very inflamed with a lot of gall stones. So because we're the ones who are operating, we're not technically um capable or confident to take out a hot gall bladder. Then we just opted to put in the college's total me and then the resection was done I think in 48 hours if I remember correctly. But I think that is really done. I stand to be corrected. But I think that is really done now because others are more confident or open to operating even ago bladder that is acutely in flint. So yeah, I don't know what is your experience with that. I think that's well said, I just wanted to make a comment. It's your bailout procedure most of the times you are planning on it, but you get in there and it's very inflamed and you're not sure the anatomy put in a college testosterone E tube and live to fight another day. That's very good advice. Um Nowadays if we have severe cardiac or pulmonary problems that can be done per cutaneous lee. But yeah, I think that for you would be a bailout procedure just like dr calmly Amba said and um well it's nice to see everyone again and meet you and hopefully uh I can tune in in the future. So Published November 19, 2021 Created by
