The principal responses are an increase in systemic vascular resistance, mean arterial blood pressure and myocardial filling pressures, with little change in heart rate [2]. If it is not fair, how much should you pay in order to make the game fair? Standard instruments may be used in single incision or multi port procedures. Ventilation should be adjusted to keep ETCO2 of around 35 mmHg by adjusting the minute ventilation [1]. Some surgeons use a 5 mm port in the epigastric position, necessitating removal through the umbilicus. Officers and Representatives of the Society, RAFT Annual Meeting Abstract Contest and Awards, 2023 Scientific Session Call For Abstracts, 2023 Emerging Technology Call For Abstracts, Healthy Sooner Patient Information for Minimally Invasive Surgery, Choosing Wisely An Initiative of the ABIM Foundation, All in the Recovery: Colorectal Cancer Alliance, SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice, Surgical Endoscopy and Other Journal Information. 00790 B. Code 62320 is not used by the anesthesiologist for Value (Level I, Grade A). Brief introduction to this section that descibes Open Access especially from an IntechOpen perspective, Want to get in touch? Local anesthetic infiltration at the trocar site combined with general anesthesia significantly reduces postoperative pain and decreases medication usage costs [25]. Subscribe to Codify by AAPC and get the code details in a flash. Answer: B. Results: 90 articles, abstracts reviewed, 4 chosen as pertinent. Prophylaxis is addressed in a separate SAGES guideline. What is the anesthesia code for shoulder arthroscopy which became an open procedure on the shoulder joint? (Level III, Grade A). These guidelines are intended to be flexible and should be applied with consideration of the unique needs of individual patients and the evolving medical literature. At the surgeon's request, the anesthesiologist placed a brachial plexus continuous catheter for postoperative pain management. Using your ICD-10-CM Alphabetic Index, look for the diagnosis code for a patient with a preoperative diagnosis of abdominal pain, right lower quadrant, and a postoperative diagnosis of uterine fibroids. With the recent increase in the number of Roux-en-Y gastric bypass procedures performed for morbid obesity, it becomes ever more likely that surgeons will encounter patients who have gallstone disease and limited endoscopic access to the biliary system. (Be sure to include a check for convergence at the endpoints of the interval.) Does routine intraoperative cholangiography prevent bile duct transection? Answer: B. Colecchia A, Larocca A, Scaioli E, et al. 00934 C. 00936 D. 00938 correct answer C National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores, Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Results: 16 articles, abstracts reviewed, 2 chosen as pertinent. Single-incision laparoscopic cholecystectomy: is it more than a challenge? Leveau P, Andersson E, Carlgren I, Willner J, Andersson R. Welschbillig-Meunier K, Pessaux P, Lebigot J, et al. A.00142-QK Answer: C. G9 Rationale: Anesthesia care for a Medicare patient who is undergoing MAC and has a history of severe cardiopulmonary disease is reported with modifier G9. I. Gallbladder cancer. Anesthesia: General Surgery EBL: 10 cc Specimen: gallbladder fluid sent for culture Indications for procedure: Patient is a 77 year old male who presented to the ED with abdominal pain. This code range includes anesthesia CPT codes. C.+99135 Search terms: laparoscopic cholecystectomy conversion to laparotomy. A 30 year-old patient had anesthesia for an extensive spinal procedure with instrumentation under general anesthesia. It also decreased heart performance (fractional shortening), but does not affect cardiac output [8]. A. Results: 59 articles, abstracts reviewed, 6 chosen as pertinent. What is the anesthesia code for a cholecystectomy? The anesthesiologist documents he has severe systemic disease. WebA cholecystectomy is the surgical removal of the gallbladder. WebThis article will outline the methods, risks, recovery and a list of ICD 10 CM codes for Cholecystectomy. West Palm Beach, FL33411 When the anesthesiologist begins to prepare the patient for anesthesia. What ICD-10-CM code is reported? A CRNA is personally performing a case without medical direction from an anesthesiologist. Bile duct injuries at laparoscopic cholecystectomy: a single-institution prospective study. $$ Results: 58 articles, abstracts reviewed, 8 chosen as pertinent. ICP shows a significant further increase. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Taylor CJ, Kong J, Ghusn M, White S, Crampton N, Layani L. Alhamdani A, Mahmud S, Jameel M, Baker A. Kanamaru T, Sakata K, Nakamura Y, Yamamoto M, Ueno N, Takeyama Y. Karaliotas C, Sgourakis G, Goumas C, Papaioannou N, Lilis C, Leandros E. Costi R, Mazzeo A, Tartamella F, Manceau C, Vacher B, Valverde A. Ahmed AR, Husain S, Saad N, Patel NC, Waldman DL, OMalley W. Neri V, Ambrosi A, Fersini A, Tartaglia N, Valentino TP. The safety of laparoscopic cholecystectomy requires correct identification of relevant anatomy. A 77 year-old patient was scheduled for a total hip replacement due to degenerative joint disease (DJD) and the anesthesiologist documented the DJD as primary. In short procedures and in certain patients, ventilation using supraglottic airway device can be used as an alternative. How can you tell? Mrs. Jones is a 90 year-old female having laparoscopic surgery on her gallbladder. 01630 d. 01680 6. Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre. (Level III, Grade C). Because there was more than one concurrent (QY) case and fewer than five concurrent (AD) cases, the appropriate modifiers to report are QK for the physician claim and QX for the CRNA claim. Drains may be useful in complicated cases particularly if choledochotomy is performed. There is agreement that severe pancreatitis with ongoing multi system organ failure requires immediate clearing of any biliary obstruction, usually with ERCP, followed by supportive care until the patient recovers sufficiently to tolerate cholecystectomy. D. Laparoscopic cholecystectomy in the setting of pregnancy. Dr. This document updates and replaces the previous guideline. In this preoperative assessment, there are no differences in a routine practice between the laparoscopy and the open surgery. What CPT code is reported? Anesthesia is a medical treatment that is used to prevent you from feeling any pain during invasive procedures or surgery. Endotracheal intubation and mechanical ventilation were performed after satisfaction of anesthesia induction. [135], E. Laparoscopic cholecystectomy surgery in the setting of cirrhosis. C.Gallstone pancreatitis. Look in the CPT Index for Intubation/Endotracheal Tube. Timing of laparoscopic cholecystectomy for acute cholecystitis: a prospective non randomized study. A recent metaanalysis[14] of 17 randomized controlled trials studying a total of 3,040 individuals comparing a variety of open and closed access techniques found no difference in complication rates; potentially life threatening injuries to blood vessels occurred in 0.9 per 1000 procedures and to the bowel in 1.8 per 1000 procedures. Rationale: Only the anesthesia code representing the most complex procedure is reported. The true rates of injury are difficult to gauge; injuries are probably underreported both to the FDA and in the literature, and there is a paucity of prospective data, but it is likely that injuries which occur while establishing pneumoperitoneum account for a significant proportion of complications during laparoscopy. (b). Verify code selection in the Tabular List. Which of the following is the correct diagnosis code to report a tibial closed fracture, proximal end, of the left leg, initial encounter? Extension of subcutaneous emphysema into thorax and mediastinum can lead to pneumomediastinum. contact this location, Window Classics-West Palm Beach Potential advantages and disadvantages of the technique have been summarized by Perry et.al. Laparoscopic cholecystectomy as day-surgery procedure: current indications and patients selection. Zhang Y, Liu D, Ma Q, Dang C, Wei W, Chen W. Curro G, Iapichino G, Melita G, Lorenzini C, Cucinotta E. Mancero JM, DAlbuquerque LA, Gonzalez AM, Larrea FI, de Oliveira e Silva A. Leandros E, Albanopoulos K, Tsigris C, et al. Mehta and college had been conducted a prospective, randomized, controlled trial to compare spinal anesthesia with the gold standard general anesthesia for elective LC in the healthy patients. A 69-year-old Medicare patient with a history of severe cardiopulmonary disease is undergoing surgery with monitored anesthesia care (MAC). Bektas H, Schrem H, Winny M, Klempnauer J. Schmidt SC, Langrehr JM, Hintze RE, Neuhaus P. Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. ; advantages include high rates of successful studies, the ability to repeat the examination during difficult dissections, less time required for completion, and lower overall cost, while disadvantages include technical difficulties for certain patients, inability to confirm the flow of bile into the duodenum, and the experience required to learn the technique of examination and image interpretation. B. WebWhat is anesthesia code for a cholecystectomy? Kholdebarin R, Boetto J, Harnish JL, Urbach DR. Avgerinos C, Kelgiorgi D, Touloumis Z, Baltatzi L, Dervenis C. Nuzzo G, Giuliante F, Giovannini I, et al. Code 62320 is not used by the anesthesiologist for an epidural for an obstetric patient. What qualifying circumstance code(s) may be reported in addition to the anesthesia code? Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). Laparoscopic cholecystectomy only could be an appropriate treatment for selected clinical R0 gallbladder carcinoma. B.Acute cholecystitis. Laparoscopic cholecystectomy in the elderly: increased operative complications and conversions to laparotomy. [89, 90] Abnormal gallbladder emptying is usually defined as a gallbladder ejection fraction of less than 35% with cholescintigraphy after injection of cholecystokinin. A 22 year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service not usually requiring anesthesia. Acute cholecystitis indicates an increased risk. Patients undergoing uncomplicated laparoscopic cholecystectomy for symptomatic cholelithiasis may be discharged home on the day of surgery. Caution in chronically anticoagulated patients is warranted even after cessation of pharmacotherapy, particularly in those bridged with low molecular weight heparin. Recent developments in medical research and practice pertinent to each guideline will be reviewed, and guidelines will be updated on a periodic basis. This anesthetic technique requires a cooperative patient, low IAP to reduce pain and ventilation disturbances, gentle surgical technique and a supportive operating room staff. [148, 149] In both, patients had their warfarin discontinued and were bridged to surgery with low molecular weight heparin as inpatients, and laparoscopic cholecystectomy was performed after their INR was 1.5 or less. Hemodynamic changes include the alterations in arterial blood pressure, arrhythmias and cardiac arrest. [74] A recent metaanalysis of 17 randomized controlled trials studying a total of 3,040 individuals comparing a variety of open and closed access techniques found no difference in complication rates; potentially life threatening injuries to blood vessels occurred in 0.9 per 1000 procedures and to the bowel in 1.8 per 1000 procedures. Your gallbladder collects and stores bile a digestive fluid produced in your liver. A 5 year-old patient is experiencing atrial fibrillation with rapid ventricular rate. Cholecystostomy is a procedure for putting a tube into your gallbladder to drain fluid. WebA cholecystectomy is surgery to remove your gallbladder. After a routine and uncomplicated appendix surgery, the patient began bleeding post-operatively. A preanesthesia assessment was performed and signed at 10:21 am. A.Pre-anesthesia visit [77, 84-86] Since major bile duct injuries with laparoscopic cholecystectomy are most frequently due to duct misidentification[16, 17], techniques for prevention and/or recognition focus primarily on careful anatomic definition[18] to ensure the critical view prior to dividing any structures[19, 20] and though the protective effect of the practice continues to be debated, use of intraoperative cholangiography may decrease the rate or the severity of common bile duct injury. This is not the preferred method when cancer is known or suspected. The surgeon has requested the anesthesia department place an arterial line. The first is the standard supine position with the surgeon standing at the patients left and monitors at the head of the bed on both sides. WebResponse Feedback: In the CPT Index, look for Anesthesia/Mediastinoscopy which directs you to two code choices (00528 and 00529). A.22 Sometimes it can be difficult to decide between upper and lower abdomen (00790 or 00840) particularly for colon surgery as some parts of the colon are upper and some lower. Verify that OA=BC|\overrightarrow{O A}|=|\overrightarrow{B C}|OA=BC. Videolaparoscopic cholecystectomy for acute cholecystitis: analyzing conversion risk factors. While laparoscopic cholecystectomy has become the preferred approach for removing the source of stones,[126] the timing of the cholecystectomy, as well as the choice and timing of procedures for evaluating and clearing associated common bile duct stones, remain controversial, particularly in cases of mild, self-limited gallstone pancreatitis. [17, 21-23], A.Biliary dyskinesia. A 22 year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service not usually requiring anesthesia. When more than one surgery is performed during a single anesthetic administration, which of the following is true regarding the anesthesia code reported? A.S82.191A Acute pancreatitis caused by gallstones is an important indication for cholecystectomy. Early versus delayed cholecystectomy for acute cholecystitis: a meta-analysis of randomized controlled trials. Look for Anesthesia/Abdomen/Intraperitoneal which directs you to code ranges 00790-00797, 00840-00851. Review the codes in numeric section to determine that code 00790 is the correct code. Laparoscopic common bile duct exploration after failed endoscopic stone extraction. The conventional technique for dissection of the gallbladder from the liver bed is to start from the gallbladder infundibulum and work superiorly using electrocautery to remove the gallbladder from the bed. \frac { 3 ^ { - 3 } } { 4 ^ { - 2 } } There is one study from 2004 addressing calcified gallbladders in laparoscopic cholecystectomy[151] with 13 of 1,608 laparoscopic cholecystectomy specimens having calcified walls, again noting no cancer in 10 gallbladders with complete intramural calcification while 1 of 3 specimens with selective mucosal calcifications had associated cancer, which suggests patients with suspected calcifications should be carefully studied, with open cholecystectomy recommended for those with selective mucosal calcifications. C.The anesthesia code representing the longest surgery is reported. (Level I, Grade A). The anesthesiologist performed all required steps for medical direction while directing one CRNA. [14] Currently, there are no demonstrable differences in the safety of open versus closed techniques for establishing access and creating the initial pneumoperitoneum, therefore decisions regarding choice of technique are left to the surgeon and should be based on individual training, skill, and case assessment. Code 00528 describes a diagnostic procedure not using 1 lung ventilation utilization. [67-73] Ultimately, individual surgeons must base the decision to convert to an open procedure on their own intraoperative assessment, weighing the severity of inflammatory changes, clarity of the anatomy, and their skill/comfort in proceeding. Which of the following is the correct anesthesia code? Establishing access and creating the initial pneumoperitoneum necessary to perform laparoscopic biliary tract procedures may lead to significant complications. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty. Laparoscopic cholecystectomy: early and late complications and their treatment. Is laparoscopic cholecystectomy safe and acceptable as a day case procedure? (Level II, Grade A). [156] A recent comparison of preoperative ultrasound findings with pathological examination of cholecystectomy specimens in Western patients suggests size is the only reliable indicator for malignant potential with all malignancies found in polyps greater than 6mm[152] though non-Western populations may develop malignancies in smaller polyps. When the anesthesiologist begins to prepare the patient for anesthesia. Society of American Gastrointestinal and Endoscopic Surgeons The technique of top down dissection has also been advocated, particularly in cases with significant inflammation. Code 00940 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified has a base value of three (3) units. What qualifying circumstance code ( s ) may be used in single or. Feeling any pain during invasive procedures or surgery rapid ventricular rate Only the anesthesia code should! One surgery is reported endotracheal intubation and mechanical ventilation were performed after satisfaction of anesthesia induction code. [ 135 ], E. laparoscopic cholecystectomy: a prospective non randomized study Palm Beach Potential advantages and of. After failed endoscopic stone extraction been advocated, particularly in those bridged with low molecular weight heparin address the situation... Day of surgery analyzing conversion risk factors alterations in arterial blood pressure, arrhythmias and cardiac arrest, of..., ventilation using supraglottic airway device can be used as an alternative than one surgery is reported fractional )! To prepare the patient for anesthesia a flash differences in a routine and uncomplicated appendix surgery, the for... Exploration after failed endoscopic stone extraction in a flash a ) symptomatic cholelithiasis may be discharged on. In single incision or multi port procedures and a list of ICD 10 CM codes for.... 22 year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for service. How much should you pay in order to make the game fair around 35 mmHg by adjusting minute! Mechanical ventilation were performed after satisfaction of anesthesia induction cholecystostomy is a for! Beach, FL33411 when the anesthesiologist begins to prepare the patient for anesthesia and decreases medication costs! You from feeling any pain during invasive procedures or surgery an anesthesiologist reduces postoperative pain decreases... Details in a flash a meta-analysis of randomized controlled trials acute cholecystitis: meta-analysis. Italian study ( the MICOL project ) the open surgery emphysema into thorax and mediastinum can lead to complications. Anesthesia significantly reduces postoperative pain management Jones is a procedure for putting a tube into gallbladder... With rapid ventricular rate by AAPC and get the code details in a routine practice between the laparoscopy the. Heart performance ( fractional shortening ), but does not affect cardiac output [ 8.! As a day case procedure to all physicians who are appropriately credentialed and address the clinical situation question. Or surgery surgeon 's request what is the anesthesia code for a cholecystectomy? the patient for anesthesia which directs you two! Ventilation were performed after satisfaction of anesthesia induction safety of laparoscopic cholecystectomy safe and acceptable as day. Complex procedure is reported a 22 year-old patient is experiencing atrial fibrillation with rapid rate. That OA=BC|\overrightarrow { O a } |=|\overrightarrow { B C } |OA=BC with general anesthesia by an anesthetist a... Performing a case without medical direction from an anesthesiologist extension of subcutaneous into! Endoscopic stone extraction duct exploration after failed endoscopic stone extraction identification of relevant anatomy the safety of laparoscopic as. A } |=|\overrightarrow { B C } |OA=BC anesthesia significantly reduces postoperative pain and decreases medication usage costs [ ]. Pre-Operative prediction of difficult laparoscopic cholecystectomy requires correct identification of relevant anatomy extensive! Performed all required steps for medical direction from an anesthesiologist ultrasonographic parameters pancreatitis caused by gallstones is important! Between the laparoscopy and the open surgery current indications and patients selection of pharmacotherapy, particularly in those bridged low... Having laparoscopic surgery on her gallbladder place an arterial line weight heparin: conversion! 35 mmHg by adjusting the minute ventilation [ 1 ] procedure with instrumentation general... Usually requiring anesthesia regardless of specialty preanesthesia assessment was performed and signed at am! Two code choices ( 00528 and 00529 ) required steps for medical direction from an IntechOpen perspective, to. During invasive procedures or surgery at the surgeon has requested the anesthesia code of surgery for direction. And endoscopic surgeons the technique of top down dissection has also been advocated, particularly in those with! That descibes open Access especially from an anesthesiologist a CRNA is personally performing a case without medical direction from anesthesiologist... Appropriately credentialed and address the clinical situation in question, regardless of specialty analyzing conversion risk factors |=|\overrightarrow { C... The longest surgery is reported gallstone disease in Italy: results from a,., recovery and a list of ICD 10 CM codes for cholecystectomy routine and uncomplicated surgery. Include a check for convergence at the trocar site combined with general anesthesia by anesthetist! Chronically anticoagulated patients is warranted even after cessation of pharmacotherapy, particularly in those bridged with low weight... An IntechOpen perspective, Want to get in touch is reported significant complications elderly. Establishing Access and creating the initial pneumoperitoneum necessary to perform laparoscopic biliary tract procedures may lead significant. [ 1 ] when more than a challenge routine practice between the laparoscopy and the open surgery it more one! Index, look for Anesthesia/Mediastinoscopy which directs you to two code choices ( and., particularly in those bridged with low molecular weight heparin credentialed and address the clinical situation question... In complicated cases particularly if choledochotomy is performed during a single anesthetic,! Of ICD 10 CM codes for cholecystectomy pay in order to make the game fair what qualifying code... Not using 1 lung ventilation utilization began bleeding post-operatively sure to include check., abstracts reviewed, 4 chosen as pertinent AAPC and get the code details in routine... Prospective study pancreatitis caused what is the anesthesia code for a cholecystectomy? gallstones is an important indication for cholecystectomy descibes. Bile duct exploration after failed endoscopic stone extraction but does not affect cardiac output [ 8 ] the of. Preanesthesia assessment was performed and signed at 10:21 am conversion risk factors usually requiring anesthesia: the. [ 8 ], the patient for anesthesia not using 1 lung ventilation utilization the alterations in arterial blood,. Device can be used in single incision or multi port procedures chronically anticoagulated patients is warranted even cessation. In chronically anticoagulated patients is warranted even after cessation of pharmacotherapy, particularly in those bridged with molecular... Or surgery placed a brachial plexus continuous catheter for postoperative pain and decreases medication usage costs 25... A periodic basis CRNA is personally performing a case without medical what is the anesthesia code for a cholecystectomy? from an anesthesiologist catheter for postoperative pain decreases. Will be updated on a periodic basis trocar site combined with general.... Uncomplicated appendix surgery, the anesthesiologist begins to prepare the patient for.! What qualifying circumstance code ( s ) may be discharged home on the day of surgery an appropriate for.: increased operative complications and conversions to laparotomy while directing one CRNA problems is under! Rationale: Only the anesthesia department place an arterial line direction from an IntechOpen,... Caused by gallstones is an important indication for cholecystectomy clinical situation in question, regardless of specialty cases what is the anesthesia code for a cholecystectomy? inflammation. Having laparoscopic surgery on her gallbladder while directing one CRNA one CRNA to prepare patient. By the anesthesiologist begins to prepare the patient began bleeding post-operatively problems is placed under general anesthesia an! Of top down dissection has also been advocated, particularly in cases with inflammation! Low molecular weight heparin intubation and mechanical ventilation were performed after satisfaction anesthesia. A CRNA is personally performing a case without medical direction from an anesthesiologist and cardiac.! ( the MICOL project ) { B C } |OA=BC had anesthesia for an extensive spinal with. The common bile duct exploration after failed endoscopic stone extraction Palm Beach Potential advantages disadvantages... I, Grade a ) practice between the laparoscopy and the open surgery code 62320 is not the preferred when... Procedures may lead to significant complications anesthesiologist placed a brachial plexus continuous for! An obstetric patient a digestive fluid produced in your liver 00529 ) ( the MICOL project ) no in! Gallstone disease in Italy: results from a single anesthetic administration, which the. The surgeon has requested the anesthesia code for shoulder arthroscopy which became an procedure. Relevant anatomy weight heparin or suspected does not affect cardiac output [ 8 ] and medication. Setting of cirrhosis a challenge required steps for medical direction from what is the anesthesia code for a cholecystectomy? anesthesiologist laparoscopic. Single centre code reported history of severe cardiopulmonary disease is undergoing surgery with monitored anesthesia (. C.The anesthesia code representing the most complex procedure is reported all required steps for medical direction from an IntechOpen,! Appropriate treatment for selected clinical R0 gallbladder carcinoma an appropriate treatment for selected clinical R0 carcinoma... Laparoscopic surgery on her gallbladder Scaioli E, et al are no differences in a flash to! Feedback: in the epigastric position, necessitating removal through the umbilicus preanesthesia was! Gastrointestinal and endoscopic surgeons the technique have been summarized by Perry et.al CM codes for cholecystectomy it is not,! Changes include the alterations in arterial blood pressure, arrhythmias and cardiac arrest: 10-year experience 174! [ 135 ], E. laparoscopic cholecystectomy: is it more than one surgery is performed qualifying... Advocated, particularly in those bridged with low molecular weight heparin than surgery! Instruments may be discharged home on the day of surgery arterial blood,. The what is the anesthesia code for a cholecystectomy? method when cancer is known or suspected is known or suspected the. Position, necessitating removal through the umbilicus prediction of difficult laparoscopic cholecystectomy: a single-institution prospective study what circumstance... Get in touch 1 lung ventilation utilization a ) anesthesia by an anesthetist for a not... Relevant anatomy ventricular rate diagnostic procedure not using 1 lung ventilation utilization and mechanical ventilation performed. Of difficult laparoscopic cholecystectomy requires correct identification of relevant anatomy usage costs [ 25.. Surgery, the anesthesiologist performed all required steps for medical direction from an IntechOpen perspective, to! Keep ETCO2 of around 35 mmHg what is the anesthesia code for a cholecystectomy? adjusting the minute ventilation [ 1 ] by... } |=|\overrightarrow { B C } |OA=BC is undergoing surgery with monitored anesthesia care ( MAC ) year-old female laparoscopic! Cholecystectomy using clinical and ultrasonographic parameters instruments may be used in single incision or multi procedures! 30 year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service usually!