Hey guys, this is your friend Dr. Singer again today. We're going to talk about an instructional educational short video of La Prescape Galber surgery. I have slowed down the steps to show all the anatomy and how we do this thing. I have already placed the trocar inside and they're placing the instrument now. In my right hand I have this pointy instrument which is called as Medleine Grasspur. This is the Galberter. This is the cystic duct. This is the cystic artery supplying to the Galberter. In my left hand I have the stubby instrument called as a bulldog or bull nose grasspur. Those are the posterior touch man. These are the anterior touch man and we're going to try to take this Galberter out shortly. Now in my hand I have this instrument called as a cotry. It is an alhock which is connected to the cotry machine. I usually score the peritonium or attachment both in the front and back part away from the cystic duct. So it is easier to dissect and make the plane and window instead of fighting and going blindly and making it bleed all over. So I just incise or made a little scoring on the peritonium and it becomes so much easier to make this window. Now I'm creating a small window between the cystic duct which is a little tube down there and the Galberter on upside. The cystic duct is a little tube that brings the bile from the Galberter to the small intestine and this little artery which is going a little branches up in the Galberter looks red. They take the blood supply to the Galberter. So the goal is to create a window between the cystic duct, artery and the Galberter. So we can see it clearly from the both side that we are in the right area. We are not damaging anything. I would divide both cystic artery and cystic duct in one single clipping because they are so close together so that I usually don't need two separate clips unless they are separate. In this case this could have been done separately or individually to sake of demonstration and education. I'm just dissecting both of them. So the cystic duct is separated. The back is a portal vein and the small thing is the cystic artery. First we are going to divide the cystic duct. So my first clip is going on the cystic duct towards the cystic duct side which is going to be left behind and the other clip goes towards the Galberter that gives me the idea how much I have room in between the clips. Usually I put three clips on the side which I'm going to leave behind and I put two clips or one clips on the side on the Galberter which I'm going to take out. So in this way it is completely safe. Now I have clip completely cystic duct. I usually put two clips on the cystic artery which is going to be left behind and one towards the Galberter side which is going to be taken out. So everything is clip now. The only thing we need to do is cut them and take the Galberter out. These are laparoscopic scissors. So first I cut the cystic duct and then cystic artery. The cystic arteries are blood supply to the Galberter. Now cystic duct and cystic artery are both cut so we're going to separate the Galberter from the liver. This is the cut tree again. We are dividing the attachment which hold the Galberter to the liver from both side. We cut or burn or divide slowly from each side and pull it away from the liver to separate it. All the small branches we can cut rise it and separate away. So from the left hand I am pulling the Galberter giving it a traction. A little bit tension on these attachment and from the right hand I'm dividing with the cut tree. All this attachment is separating from the liver surface. As you see with this cut tree even though I keep it very low there are no bleeders. There is no bleeding and it is very safe. It does create a little bit of fumes in there which sometimes it makes it difficult to see but you can always get the fume comes out and continue to do your surgery. The surgery is pretty quick and this one is very clean. When you say if there is no biolique there is no blood loss and it is done in less than 20 minutes. So we continue to go up towards the head of the Galberter which we call technically as a fundus. So we are dividing all this attachment and we are just about done to separate the Galberter from the liver surface. As you see on the liver surface there is no bleeding and Galberter is almost separated from the liver. So now next thing we need to do to take this Galber outside the abdominal cavity or belly or stomach in a layman ward. So it is very interesting to how we take out the Galberter without spilling it. You can pull it directly like that but I usually like to put this in a little back, this end of pouch. It has got a little too steep prongs on the side so you put the Galberter inside and then we can close it. It closes like a parts of string. So if there is stones or balls it does not spill inside the abdominal cavity, minima the chance of infection or contamination. That plastic tube coming is from the outside which is a trocar and this is the abdominal wall and you pull the Galber out and you are done. Don't forget to subscribe, watch, comment, share and call me if you have any questions. You guys have a great night.