Laparoscopic cholecystectomy has become the gold standard for the surgical management of gallbladder diseases, particularly cholelithiasis (gallstones) and chronic cholecystitis. The procedure involves the removal of the gallbladder using minimally invasive techniques, offering reduced postoperative pain, shorter hospital stay, faster recovery, and improved cosmetic results compared to traditional open surgery. Dr. R.K. Mishra, a pioneer in minimally invasive surgery, has refined laparoscopic cholecystectomy techniques to enhance safety, efficiency, and outcomes for patients worldwide.

Indications

Laparoscopic cholecystectomy is indicated in:

Symptomatic Gallstones: Patients with recurrent biliary colic, dyspepsia, or biliary obstruction.

Acute or Chronic Cholecystitis: Inflammation of the gallbladder due to gallstones or infection.

Gallbladder Polyps: Especially when larger than 1 cm or symptomatic.

Biliary Dyskinesia: Dysfunctional gallbladder motility causing pain.

Gallbladder Complications: Such as empyema, mucocele, or porcelain gallbladder.

Proper preoperative evaluation includes ultrasonography, liver function tests, and other imaging modalities if needed, ensuring accurate diagnosis and safe surgical planning.

Preoperative Preparation

Preoperative assessment involves:

Comprehensive medical and surgical history, including previous abdominal surgeries.

Physical examination to assess abdominal tenderness and body habitus.

Laboratory investigations, including liver and renal function tests, complete blood count, and coagulation profile.

Patient counseling regarding the procedure, anesthesia, possible complications, and expected recovery.

Patients are advised to fast for 6–8 hours prior to surgery and may receive prophylactic antibiotics to prevent infection.

Surgical Technique

Dr. R.K. Mishra has developed advanced techniques to simplify laparoscopic cholecystectomy while maximizing safety and minimizing complications. The surgery is performed under general anesthesia using the following approach:

Patient Positioning and Port Placement:

The patient is placed in a supine position with reverse Trendelenburg tilt and slight left tilt to improve visualization of the gallbladder. Typically, four ports are inserted:

Umbilical port (10 mm) for the laparoscope

Epigastric port (10 mm) for dissection instruments

Two lateral ports (5 mm each) for retraction and additional instrumentation

Exposure and Dissection:

The gallbladder is grasped and retracted to expose Calot’s triangle—the critical area containing the cystic duct, cystic artery, and common bile duct. Meticulous dissection is performed using electrocautery or ultrasonic devices. The critical view of safety is obtained to clearly identify and isolate the cystic duct and artery, minimizing the risk of bile duct injury.

Mishra’s Knot Technique (if applied):

In certain cases, Dr. Mishra may employ his innovative Mishra’s Knot technique for ligating the cystic duct, which simplifies the process, ensures secure closure, and reduces operative time.

Cystic Duct and Artery Ligation:

Both the cystic duct and artery are clipped and divided, ensuring hemostasis and preventing bile leakage.

Gallbladder Separation:

The gallbladder is carefully dissected from the liver bed using electrocautery. Special attention is given to control minor bleeding points and to avoid injury to surrounding structures.

Specimen Retrieval:

The gallbladder is placed in a retrieval bag and removed through the umbilical port, preventing spillage of bile or stones into the abdominal cavity.

Closure:

The ports are removed, pneumoperitoneum is released, and the fascial and skin layers are closed using absorbable sutures or subcuticular technique for optimal cosmetic results.

Postoperative Care

Patients typically experience minimal pain and are encouraged to ambulate early. Oral intake is usually resumed within a few hours post-surgery. Postoperative care includes monitoring for:

Bleeding or hematoma formation

Bile leakage

Infection at port sites

Most patients are discharged within 24–48 hours, with full recovery expected within 7–10 days.

Outcomes and Advantages

Dr. R.K. Mishra’s laparoscopic cholecystectomy has demonstrated excellent outcomes worldwide:

Reduced postoperative pain compared to open surgery

Shorter hospital stay and faster return to normal activities

Lower complication rates, particularly due to meticulous dissection and critical view identification

Superior cosmetic results with minimal scarring

Applicability in complex cases such as acute cholecystitis, empyema, or cirrhosis

Conclusion

Laparoscopic cholecystectomy by Dr. R.K. Mishra exemplifies the evolution of modern minimally invasive surgery. By combining technical expertise, innovative methods such as Mishra’s Knot, and meticulous attention to anatomical detail, this approach provides safe, effective, and patient-friendly management of gallbladder diseases. Patients benefit from rapid recovery, reduced postoperative discomfort, and excellent long-term outcomes, making this technique a benchmark in gallbladder surgery globally.