Common Diseases of the Gallbladder that often require gallbladder removal (Cholecystectomy):

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Biliary colic — Biliary colic is characterized by a sudden onset of sharp pain in the right and/or middle upper abdomen that is often associated with nausea and vomiting.  Biliary colic often occurs shortly after eating a fatty meal and is usually caused by gallstones.  Gallstones form when substances in the bile crystalize, and they can be as small as a grain of sand or larger then a golf ball. The diagnosis of biliary colic is made based on the presence of classic symptoms and findings of gallstones on an ultrasound.

Cholecystitis — Cholecystitis is caused by an infection of the gallbladder that is typically due to gallstones.  It is characterized by the same symptoms as biliary colic, but the abdominal pain is often more severe and associated with a fever.  The diagnosis of cholecystitis is made based on either an ultrasound or a CT scan.

Biliary dyskinesia — Biliary dyskinesia is characterized by sharp or crampy pain in the right and/or upper middle abdomen. It is associated with nausea and usually occurs after eating a fatty meal.  Biliary dyskinesia is caused by a poorly functioning gallbladder that has a decreased ability to send bile to the intestines. The diagnosis of biliary dyskinesia is made by a HIDA scan that shows a low ejection fraction.

Gallbladder polyps — Gallbladder polyps are usually found incidentally when an imaging study is done for another reason.  They rarely cause any symptoms, and when small (< 1 cm), they can simply be observed without need for surgery.  When a gallbladder polyp becomes 1 cm or larger in size, however, then the gallbladder and polyp should be removed because these larger polyps have an increased likelihood of containing cancer.

Gallstone pancreatitis — Gallstone pancreatitis can occur when a gallstone leaves the gallbladder and travels down the bile duct.  As the gallstone passes down the bile duct, it can cause inflammation of the pancreas leading to pancreatitis.  Pancreatitis can be mild and last for several days, but it can also be a severe life threatening condition.

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How is gallbladder removal surgery (cholecystectomy) performed?

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A cholecystectomy is the surgical removal of the gallbladder, and it is one of the most common surgical procedures performed in the United States.  Nearly 20% of adults will develop gallstones, but only 10% of individuals with gallstones will develop symptoms and need their gallbladder removed.  Traditionally, gallbladders were surgically removed with a technique termed an open cholecystectomy, where  a large 8 to 12 inch incision was made in the upper abdomen. After the procedure, patients stayed in the hospital for several days with significant pain and had a long recovery process as well.  Fortunately, beginning in the early 1990s, a new technique for gallbladder removal emerged called laparoscopic cholecystectomy.  A laparoscopic cholecystectomy is performed by making four small incisions in the abdomen and inserting a small video camera and thin instruments through these incisions to remove the patient's gallbladder.  This new technique, also known as minimally invasive surgery, allows most patients to go home the day of surgery with much less pain, and it results in a much quicker recovery.

The FDA approved a new device to perform robotic assisted surgery in 2000, and initially these robots were primarily used by urologic surgeons to perform prostate removal surgeries.  Over the last decade, the benefits of robotic assisted surgery have been widely published, and the technology is now commonly used for general surgery cases, including cholecystectomies.  A robotic assisted laparoscopic cholecystectomy is very similar to a standard laparoscopic cholecystectomy, as four small (less than ½ inch) incisions are made through which a small video camera and thin instruments are used to remove the gallbladder.  The robot holds these thin instruments, but the robot is always under complete control by the surgeon.  The advantages of a robotic assisted laparoscopic cholecystectomy over a standard laparoscopic cholecystectomy are the following: a three dimensional high definition view of the gallbladder and surrounding tissues, much more precise instruments that can rotate 360 degrees rather than simply open and close, and a visual mapping of bile ducts to decrease the risk of injury. In addition, patients who undergo a robotic assisted laparoscopic cholecystectomy also experience a faster recovery, less pain after surgery, and require significantly less narcotic pain medication compared to those undergoing a standard laparoscopic cholecystectomy. Dr. Mueller performs a high volume of robotic assisted laparoscopic cholecystectomies at Northwestern Memorial Hospital and continues to observe excellent patient outcomes. 

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