Laparoscopic/Robotic Cholecystectomy
Date issued: March 2025
For review: March 2027
Ref: A-64/GS/Surgery/gallstones V2
PDF: Laparoscopic Robotic Cholecystectomy.pdf [pdf] 391KB
What is the Gallbladder?
The gallbladder is a small pear sized organ that stores bile. Bile is necessary for the digestion of fatty food. The bile duct is a tube that carries bile from the liver to the bowel and attached to this is the gallbladder. However, the gallbladder is not an essential organ, and you are able to continue to digest fatty food without it, although about half the people who have their gallbladder removed have some indigestion or bloating from time to time.
What are Gallstones?
10-15% of adults develop gallstones. Gallstones form in the gallbladder, most commonly due to an imbalance in the chemical constituents of bile.
What problems do Gallstones cause?
Gallstones are common and often cause no problems. However, in some people they can cause:
Pain: This arises if gallstones block the outlet from the gallbladder. It can last minutes to hours and resolve spontaneously (biliary colic). It may however last longer, with infection of the gallbladder (cholecystitis), often requiring antibiotics.
Pancreatitis: Inflammation of the pancreas gland can occur if a stone passes down the bile duct and irritates the opening to the pancreas.
Jaundice: This is a condition in which a patient turns a shade of yellow, often most noticeable in the white of the eyes. It is due to a stone moving from the gallbladder into the bile duct and partially blocking the flow of bile into the bowel. If this occurs, your urine may become darker, faeces lighter, and your skin may itch.
How are Gallstones treated?
A low-fat diet may help reduce the pain due to gallstones.
There are no drugs available which can reduce the symptoms arising from gallstones by dissolving them.
The best method to remove the symptoms arising from gallstones is to perform an operation to remove the gallbladder. If only the stones are removed, leaving the gall bladder in place, the stones will re-form.
What does the operation involve?
Both the gallbladder and stones are removed. This can be done as a laparoscopic or robotic (keyhole) procedure under general anaesthetic (you are completely asleep), through four small holes, each 1-2 cm in length, made in the tummy wall. Occasionally it is not possible to complete the operation by the keyhole method and a bigger incision (cut) is needed. The chance of the keyhole operation being converted to an open operation is about 5%.
If your surgeon is concerned that gallstones may have dropped into the bile duct causing a blockage, they may perform an ultrasound examination of the bile duct during your surgery. If stones are found in the bile duct, they may proceed to a further procedure called a bile duct exploration to remove these stones. If they suspect this may be required, they will explain it to you in more detail beforehand.
What are the possible complications?
The operation is usually straightforward, and you will either be able to go home on the day of surgery or the following day. There are however risks with any operation and although they are rare, these are detailed below:
Shoulder pain: This often happens after keyhole surgery but tends to last less than 24 hours. It is due to the gas used to inflate the inside of the abdomen during the operation.
Infection: This can occur in the wound(s), in the lungs, at the site of the intravenous drip, or at the position where the gall bladder was located.
Bleeding: This can occur during or after the operation, as with any surgery.
Bile leak: Bile can leak from the surface of the liver or the main bile duct after the operation. This may settle of its own accord, but in some cases may require further intervention.
Damage to surrounding structures: Rarely, nearby structures can be damaged inadvertently during this operation, as with any operation. These structures include the bile duct, bowel, and the blood supply to the liver. A bile duct injury is potentially very serious but is rare, occurring in approximately 1 to 2 in every 1000 operations.
Deep Vein Thrombosis (DVT) / Pulmonary Embolus (PE): Clots forming in the veins can occur with any surgery, but the risk is increased with laparoscopic surgery. If you stay in hospital overnight, we will give you a blood thinning injection to decrease this risk. Once you are home and relatively mobile, these injections are not required.
Retained Stone: Before or during the operation a stone can move into the bile duct. This often causes no problem and passes into the bowel. However, if it does not pass, a second procedure may be necessary to remove it.
What about pain after the operation?
Keyhole surgery usually involves less pain than open surgery. Several methods are used to minimise the pain that may be experienced:
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injecting the wounds with local anaesthetic while you are asleep
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pain killing medications are given to you before the operation which will continue to work after the operation
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pain relief medications are given to you after the operation; you will be given a supply of pain relief tablets to take home if required
Is there any aftercare for the wounds?
The four small holes are usually glued and/or stitched with dissolvable stitches and so do not need to be removed. Glue and plastic dressings are shower proof, but if fabric dressings are used these should be kept dry for 48-72hrs and then can be removed.
What about the recovery?
You may eat and drink as soon as you like following surgery. After assessment by a nurse and / or the surgeon, you may be able to go home in the late afternoon or early evening. After keyhole surgery, you are likely to feel tired for a day or two. Full recovery takes about 2 weeks. With open surgery, the average is 4 weeks.
Pain and nausea
It is normal to have some pain and discomfort in your abdomen for 3-4 days after your operation. This will gradually get better as time passes. A sore throat is common for a few days. Nausea and sickness may occur when you start to move around; you may find it helpful to lie down and rest quietly and the nausea will usually pass.
Bowels
It is quite usual for your bowels not to open for a day or two following surgery. Should you feel uncomfortable after this, please consult your General Practitioner.
Returning to work
You will be able to go back to work fairly quickly depending upon how physically demanding your job is. The average is 2 weeks after keyhole surgery, and 4 weeks after open surgery, although it may take longer and some people will require some amendments to their duties initially.
Driving
You may drive as soon as you are able to tolerate the seat belt and make an emergency stop without causing discomfort - usually after 1-2 weeks following keyhole surgery and 2-3 weeks following open surgery. If you drive as part of your job, please discuss this with your employer.
Longer Term
Once you have recovered from the operation there is no long-term restriction on what you can eat or drink. Some patients find that rich / fatty food gives them some discomfort and diarrhoea, but this usually settles with time.
Check-ups
The majority of patients recover quickly after this type of surgery and do not have to be seen again. If there are specific reasons to be seen after the surgery, this will be arranged before discharge.
If problems occur in the first 24-48 hours and you need information or advice, please telephone Postbridge ward on 01752 431225.
In an emergency, please attend the Emergency Department or ring for an ambulance.
After 48hrs if you are worried that something isn’t right, please contact your Surgeon’s secretary via:
plh-tr.hpb-secretaries@nhs.net
or switchboard.
Out of hours please call NHS 111
