SEPTEMBER 2020 • Volume 14, No. 9

From the Editor

Autumn greetings!

This month we take for our surgical topic the gallbladder and gallbladder surgery. Cholecystectomy, or surgical removal of the gallbladder, is one of the procedures NIFA teaches in our hands-on SutureStar Workshops and one of the most common OR procedures in the US today. In this issue we bring you some items of interest and news about this little bile receptacle and its surgical removal.

Our Student in the Spotlight is Courtney Mathis, MSN, APRN, WHNP-BC, of Madison, WI.

Scroll down for jobs we’ve collected for you, and NIFA’s favorite links.


Julie Lancaster, Editor

Reminder: Afterhour Webinars

This month we continue our new interactive program: NIFA Afterhour Webinars, scheduled during evening and weekend daytime hours. Designed for current students, but open to all who would like to participate, ask questions and learn! Call 800-922-7747 to register.

  • Thurs, Oct 1, 7:30pm EST – GARY HARGREAVES, President, NIFA Medical Billing, on what procedures RNFAs get reimbursed for, “Can I bill in my state?” “Is it worth becoming an APRN/RNFA versus an RNFA?” and other billing questions. 
  • Sat, Oct 10, 11am EST – KIMBERLY JONES, MSN-Ed., RN, CNOR, RNFA, on navigating an online RNFA course, testing/remediation, case logs and documentation, and reviewing the grade report. 
  • Sat, Oct 22, 11am EST – KIMBERLY JONES, MSN-Ed., RN, CNOR, RNFA, same topics as above.
  • Tues, Oct 27, 7:30pm EST – DR. JOHN RUSSELL, DNP, APRN, FNP-BC, RN CCRN, RNFA – Introduction to the OR as an APRN, how your skill levels affect your employment, negotiating your RNFA training based on billing plans, and more.

Cholecystectomy Basics

The gallbladder is small, hollow, pear-shaped organ located under the liver. It receives and stores bile, then releases bile into the duodenum to help the body digest fat. Gallstones can develop when the bile becomes saturated with cholesterol, bile salts or bilirubin (bile pigment). Although some gallstones have no noticeable effects, some get larger and/or begin to obstruct bile ducts, causing significant pain.

Until the late 1800s, doctors worked to open the gallbladder and remove gallstones, but didn’t believe humans could survive without the organ. Then, in 1882, a 27-year-old German physician, after practicing on a cadaver, surgically removed the gallbladder of a man who had suffered from gallstones for 16 years, and cured his condition overnight.

These days, cholecystectomy, surgical removal of the gallbladder, is often performed on patients who experience recurring incidence of painful gallstones. It is also a treatment for acute inflammation of the gallbladder caused by an interruption in the bile flow; various complications from gallstone disease; and gallbladder cancer. It was formerly believed that porcelain gallbladder, a condition in which the gallbladder’s inner wall is encrusted with calcium, was associated with malignancy and that the gallbladder should be removed, but the current opinion is that the risk of malignancy is very small.

More than 1.2 million cholecystectomies are performed annually in the U.S., and 92% of them are done laparoscopically, according to a paper by Mark W. Jones and Jeffrey G. Deppen that was updated just last month in the National Center for Biotechnology Information.

“The anatomy of the biliary tree remains one of the most variant areas of the body,” Jones and Deppen write. “There are many anatomical variances such as choledulco cysts, fusiform gallbladders, accessory ducts, intrahepatic gallbladders, and duplications.”

Because of this variability, some cholecystectomies that begin laparoscopically are converted midway through to open procedures due to visibility problems and other challenges presented by the patient’s biliary anatomy, or excessive inflammation, uncontrolled bleeding or other factors.  “Conversion to open cholecystectomy should not be viewed as a complication or a failure but just the opposite,” Jones and Deppen say. “It is showing good judgment to complete the operation in the safest manner possible.”

Some cholecystectomies are planned in advance as open procedures, particularly when there are other comorbid conditions present.

Here’s a useful summary chart about Cholecystectomy from the American College of Surgeons, Education Division.

Cholecystectomy News

Gallbladder surgery during pregnancy may be safer than waiting

This study reviewed the records of 6,390 women who were admitted to a hospital for cholecystitis while they were pregnant, and shows that those who did not have gallbladder surgery while pregnant were three times more likely to have a variety of complications at the birth of their child. 
Read more . . .

Achieving the ‘Holy Grail’ in Laparoscopic Cholecystectomy

by Frederick L. Greene, MD. This article in General Surgery News reports on recent recommendations from a task force focused on reducing the rate of bile duct injury (BDI) as a result of laparoscopic cholecystectomy. Dr. Greene believes the report should be “mandatory reading for every practicing surgeon and surgical trainee.” 
Read more . . .



The Mount Sinai Surgical Film Atlas: Laparoscopic Cholecystectomy. A teaching presentation that combines medical illustrations, procedural footage, and a clear narration. Watch video . . .

Robot-Assisted Single-Site Gallbladder Removal (Full-Length Surgery) – Performed at Mary Greeley Medical Center. Watch video . . .

Prevention of Bile Duct Injury: Exit strategies for the difficult gallbladder. When and how to convert to open cholecystectomy, by Society of American Gastrointestinal and Endoscopic Surgeons. Watch video . . .

Student Spotlight: Courtney Mathis


Student Status
Current student in NIFA’s RNFA program

City & State
Madison, MS

Current Position
Nurse Practitioner at Mississippi Urology Clinic, Jackson, MS

Where did you get your degrees? 
I got my RN degree at William Carey University, Hattiesburg, MS, and my MSN at Vanderbilt University, Nashville, TN.

Why did you want to become a nurse in the first place?
I’m not one of those people that grew up knowing what they wanted to be. I struggled through college not having a goal. It was only after I started working in the real world that God showed me what it was to care for people.

I was encouraged to apply to nursing school, and when I was accepted I was floored. But I took to nursing like nothing ever before. I had purpose and passion, and everything clicked.

How did you come to choose perioperative nursing?
I have always been in surgical environments. From the SICU at Vanderbilt to L&D as circulator, and now as an NPFA [Nurse Practitioner First Assistant].

What is the scariest moment you’ve ever seen at the table?
During a routine Cesarean (planned), the anesthesiologist confused the metoprolol with succinate and the patient was paralyzed before we had even started the case! It reversed quickly but it was terrifying!

What is one technique or RNFA trick you’ve learned from NIFA that you will use for life?
How to tuck my knots!

How do you feel having your RNFA will impact your life/career?
This has taken my capabilities to a whole new level. I consider myself a “hands on” personality so clinic can be a bit monotonous, but being able to get back in the OR is awesome!!

Jobs Front

Click here for the RNFA job postings we’ve collected for you this month.

NIFA – Office Hours

Monday-Thursday, 8:00am – 4:00pm
Friday, 8:00am – 3:00pm

Practice Resources

Here are several of the most-in-demand sites for our students, prospective students and grads:

MD Edge Surgery News: Specialty News and Commentaries, Videos and More
RNFA Scope of Practice by State (PDF)
ACS List of Cases that Require an Assistant at Surgery, 2020 (PDF)
Perioperative Nurse Links (state nursing boards & professional associations)
APRN Nurse Links

Disclaimer: The views expressed in this newsletter are strictly those of their respective authors and do not necessarily represent the views of NIFA. NIFA does not give any express or implied warranty as to the accuracy of statements made by our contributors and does not accept any liability for error or omission. It is the responsibility of all perioperative personnel to work within and adhere to their facility bylaws and individual scope of practice.

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