About the Gallbladder
(Skip to the bottom of this page to read about single site robot surgery)
The gallbladder is a small, pear-shaped organ, which lies on the underside of the liver, in the upper right portion of the abdomen. It is connected by ducts (or tubes) with the liver, and with the upper portion of the small intestine (duodenum).
The liver produces bile (a substance that is essential for digesting fats) and secretes it into the gallbladder where is concentrated and stored. When food is eaten, especially fatty or greasy foods, the gallbladder contracts and forces bile out the ducts leading into the intestine. When the gallbladder is removed, this function continues. Only the storage function of the gallbladder is lost. Most patients cannot tell any difference once the gallblader is removed, other than the lack of pain.
Symptoms of Gallbladder Disease
- Frequent bouts of indigestion, especially after eating fatty or greasy foods, or certain vegetables such as cabbage, radishes, or pickles.
- Nausea, heartburn, and bloating.
- Attacks of sharp pains in the upper right part of the abdomen. There is often radiation of pain into the upper back.
- Jaundice (yellowing of the skin) may occur when the bile duct is blocked.
Low Fat Gallbladder Diet
For a limited time before the gallbladder is surgically removed, a low fat, mildly spiced diet is important. This will limit symptoms and can help prevent gallbladder attacks. Eat as wide a variety of the allowed foods as possible. After surgery you may slowly start to reintroduce normal foods back into your diet.
Good Foods (non fat/low fat)
Non-fat milk, Coffee, Tea (With Non-Fat Creamer)
Sodas, Fruit drinks
White, Wheat, Grain & French breads
Cooked or Dry Cereal, Oatmeal,
Cream of Wheat (only non-fat milk with cereals)
Saltines, Graham Crackers
Lean Meats - White Fish, Poultry/No Skin
(Baked, Broiled, or Barbecued-NOT FRIED)
Egg (Poached or Boiled) - One per Day
Low-Fat Cottage Cheese
Broth , Low-Fat Chicken or Vegetable Soup
Vegetables - Steamed, Baked, or Raw
Fruits - All
Honey, Jam. Jelly
Sugar, Salt, Pepper, Syrup
Small amount of Spices, Herbs & Seasonings
Angel Food Cake
Pudding (Made With Non-Fat Milk)
Bad Foods (high fat)
1% Milk, 2% Milk, Whole Milk
Cream, Whipped Cream, Coffee Creamer
Doughnuts, Croissants, Breakfast Sandwiches
Hamburgers, Hot Dogs, Salmon
Fried Meats, Fried Eggs
Pizza, Spaghetti, Lasagna
Chili, Creamed Soups
Highly Spiced or Seasoned Casseroles
Creamed, Fried or Au-Gratin Vegetables
Pickles, Avocado, Olives
Butter, Margarine, Oil
Ice Cream, Ice Milk
Cheesecake, Chocolate Cake
Treating Gallbladder Disease
The only curative treatment for gallbladder disease is surgical removal of the gallbladder. When stones are present and causing symptoms, or when the gallbladder is infected, inflamed, or malfunctioning, removal of the organ is usually necessary.
About Laparoscopic Cholecystectomy
The surgeon creates four very small incisions of less than half an inch each. The patient’s abdomen is distended with carbon dioxide gas. The surgeon then inserts a camera called the laparoscope, which allows him to see inside the body. The other incisions in the abdomen are for specialized instruments to grasp and free the gallbladder from its attachments.
Occasionally a special x-ray study is performed in surgery called a cholangiogram. This involves injecting dye into the bile ducts. With this test the surgeon is able to search for blocking stones or other problems that might involve the bile ducts.
Many patients are able to go home the same day, although occasionally it may be necessary to spend the night.
If any of the CO2 gas remains after surgery, it can cause shoulder pain. This is from irritation of the Phrenic Nerve in the diaphragm. Any remaining gas is usually absorbed within 1 - 2 days. Raising your hips on pillows so that they are higher then your shoulders can relieve the shoulder pain. This allows the gas to move and the pain to subside.
Patients should always be prepared for the possibility of having to undergo a conventional open cholecystectomy with a large incision if problems are encountered during their surgery. They might also need endoscopy or other procedures if stones are lodged in the bile ducts, or if a bile leak develops. These situations are fortunately very uncommon.
Robot Gallbladder Surgery
The newest innovation in gallbladder surgery is Robotic Surgery. The robot offers unprecedented surgical precision, and we are now offering robotic gallbladder surgery for selected patients. The robot doesn't eliminate all risk, but it's benefits are significant, and we are happy to move into the next important developments in surgery.
Single Site Robotic Surgery
One of the most exciting advances with robot surgery is the transition to single incision surgery. New and evolving technology and equipment, have allowed increasingly complicated surgical procedures. We are now able to perform these same complicated cases with only a single incision in the umbilicus. All of the safety we have learned with 4 incision laparoscopic surgery is now possible with a single bellybutton incision. Neither robotic surgery nor single-incision surgery is new. In fact, we have been using both techniques for some time. However, combining the advantages of the robot, with the faster recover and minimal scaring of single site is very new. At the Center for Minimally Invasive Surgery, we have embraced this new advancement, and have been among the first to offer it to our patients. At this point, only gallbladder surgery is offered by single incision. However, as the technology advances, the sky is the limit. Dr Rifenbery was the first surgeon in the South Puget Sound Region with the necessary training and experience to be able to offer this innovative technique. Our team has performed more of these procedures then any other center in the region.
Unlike traditional robotic surgeries requiring three to five small incisions, this new technology allows for a single incision in the belly button where instruments are placed and the diseased gallbladder is removed. The surgery can be performed in under one hour, with most patients going home the same day.
Potential benefits of single-site gallbladder surgery include:
- virtually scar-free results
- minimal pain
- low blood loss
- fast recovery
- a short hospital stay
- high patient satisfaction
During the procedure, the surgeon sits comfortably at a console, viewing a three-dimensional, high-definition image of the patient’s anatomy. The surgeon uses hand-held controls to move the instrument’s arms and camera. In real-time, the system translates the surgeon’s hand, wrist and finger movements into precise movements of the miniaturized instruments inside the patient.
More than one million people in the U.S. have their gallbladders removed each year. Most are performed with traditional laparoscopy using several incisions. However, most people who require gallbladder removal are now candidates for robotic, single-incision surgery. Dr Rifenbery is a recommended surgeon by the da Vinci company. He also serves as a proctor, training surgeons all over the United States on this equipment.