Laparoscopic cholecystectomy (keyhole surgery)
This is now the more common way of performing a cholecystectomy. In a small minority of patients, the operation might begin as laparoscopic, but progress to an open procedure due to complicating factors such as significant infection or scarring in the area.
Your surgeon usually makes around four small incisions in the abdomen; commonly one is just under the belly button and three are below the right lower ribcage (although the number and position may vary for each individual). The incisions range from about 0.5-2.5cms long.
Carbon dioxide is blown into the abdomen to lift the abdomen wall away from the gallbladder and other organs, and enable the surgeon to view the gallbladder and surrounding area clearly. Images are projected from a small camera on the tip of the laparoscope onto a monitor. The other incisions are required to insert instruments necessary for the removal of the gall bladder, which is brought out via one of the incisions.
Metal clips, made of surgical grade stainless steel, are used to seal the blood vessels leading from the gallbladder to the other tubes (ducts) and the arteries leading to the gallbladder. These clips remain in the body on a permanent basis and don’t cause any problems. They’re not detected when you pass through a metal detector.
As soon as the gallbladder is taken out, all the instruments are removed from the abdomen. The carbon dioxide is then allowed to escape and the small incisions are closed with staples or stitches.
Open cholecystectomy (laparotomy)
The gallbladder is removed through one large abdominal incision of about 10cm just under the right rib cage. Although it's more invasive than a laparoscopic procedure, the surgeon is afforded a better view and easier access which may be required for more complex procedures.
Essentially, the technique for removing the gall bladder from the surrounding structure is the same as for the laparoscopic procedure. A small tube, or drain, is usually inserted to ensure safe removal of any residual blood or fluid from your abdomen. Some surgeons will routinely x-ray the bile ducts at the time to ensure there are no residual stones that need to be removed.