The Cholecystectomy Procedure: What Happens on the Day of Gallbladder Removal

A cholecystectomy is done under a general anaesthetic, so you are fully asleep, and in the standard keyhole version the surgeon works through three or four small cuts, inflates the abdomen with gas, and uses a camera to free and remove the gallbladder, usually in about 1 to 2 hours. The organ is lifted out through one of the small cuts, and most planned keyhole operations are a day case or a single overnight stay¹.

The operation itself turned out to be the part I remember least. I was wheeled round, asked to count backwards, and woke up in recovery with it already done and a nurse offering me tea. What I had wanted beforehand was a plain account of what happens in that missing hour: where the cuts go, what the surgeon actually does inside, and why it can change partway through. This is that account, written from the other side of my own laparoscopic cholecystectomy and checked by a consultant general surgeon. The whole procedure sits inside the bigger picture of gallbladder removal.

Before the first cut

Gallbladder removal always needs a general anaesthetic, so the day begins with pre-operative checks, a period of fasting, and being put fully asleep before anything starts. You are not awake and feel nothing during the operation; the anaesthetist stays with you throughout, monitoring your breathing and keeping you under¹.

On the day I arrived fasted since the night before, changed into a gown, and went through the same questions several times over: allergies, what I had eaten, which side the pain had been. A surgeon marked me, an anaesthetist talked me through what would happen, and then it was the trolley, the count, and nothing. The detail of being put under, and the pre-op checks that lead up to it, is set out in cholecystectomy anaesthesia.

The keyhole cuts and the camera

In laparoscopic surgery the surgeon makes three or four small cuts, each roughly 0.5 to 1 cm, then inflates the abdomen with carbon dioxide gas to create space and passes a camera and long thin instruments through the openings. One cut sits at or near the navel for the camera, and the others are spread across the upper abdomen for the instruments².

The gas is what lets the surgeon see: it lifts the abdominal wall away from the organs like a dome, so the gallbladder, liver and ducts come into view on a screen. It is also the reason for the odd shoulder-tip ache afterwards, as some gas lingers and irritates the diaphragm for a few days. The standard keyhole operation, step by step, is covered in keyhole gallbladder surgery.

What the surgeon does inside

With the gallbladder in view, the surgeon carefully identifies and confirms the two structures that must be divided, the cystic duct and the cystic artery, clips them, cuts between the clips, and then peels the gallbladder off the liver bed. Confirming the anatomy first, an established safety step often called the critical view of safety, matters because the main bile duct runs close by².

Nothing is divided until the surgeon is certain which tube is which. That deliberate caution is the whole point: the small margin between a routine removal and damage to the main bile duct is exactly what the critical view is designed to protect. Once the duct and artery are safely clipped, the gallbladder, stones and all, is separated from the liver and freed for removal.

Checking the bile duct

If a stone is suspected in the main bile duct, the surgeon may take an X-ray of the ducts during the operation, called a cholangiogram, and clear the duct if a stone is found, sometimes with a separate endoscopic procedure. This is why the anatomy is mapped so carefully before anything is divided³.

Not everyone needs this. It is added when the history, blood tests, or scans hint that a stone has slipped out of the gallbladder into the main duct, where it can cause jaundice or pancreatitis. Clearing it during or around the same admission saves a second problem later. My own operation was a straightforward one with no duct stone, so this step was not needed.

Removing the gallbladder and closing up

The freed gallbladder is placed in a small retrieval bag and drawn out through one of the cuts, usually the one at the navel, and the small incisions are then closed with stitches or glue and covered with simple dressings. Because the openings are so small, no drain is usually needed after a routine keyhole removal¹.

Pulling the organ out through a cut barely a centimetre wide sounds improbable until you realise the gallbladder is soft and the bag protects the wound. I came round with four small dressings, one hidden in my navel, and honestly could not believe an entire organ had come out through them. How those cuts heal and fade is set out in recovery week by week.

When keyhole becomes open

Around 5 to 10% of planned keyhole operations are converted to open surgery during the procedure, more often when the gallbladder is badly inflamed, scarred from earlier surgery, or the anatomy is unclear, and this is a safety decision rather than a complication. An open operation uses a single larger cut of about 10 to 15 cm under the right ribs instead of the small keyhole ones¹.

A surgeon who opens up for a difficult gallbladder is doing careful surgery, not failing at the keyhole version. Converting means a longer stay and a longer recovery, but it is the right call when the small-cut approach is no longer safe. The two approaches, and when each is chosen, are compared in laparoscopic versus open cholecystectomy.

How long it takes and where it is done

A straightforward keyhole removal takes roughly 1 to 2 hours, while a difficult or open operation takes longer, and planned keyhole surgery is often a day case or a single overnight stay. An open operation, or an emergency for acute cholecystitis, usually means a few days in hospital¹.

For me it was a same-day keyhole removal: in during the morning, awake and drinking tea by the afternoon, home by the evening with a bag of painkillers and four small dressings. Being sent home so soon felt startling for something billed as major abdominal surgery, but keyhole surgery is why so many people manage exactly that. The gallbladder itself is not essential, so once it is gone the liver simply carries on making bile that drips straight into the intestine⁴.