Protocol for laparoscopic cholecystectomy: Is it rocket science?

Figure 5 Tips and pitfalls of laparoscopic cholecystectomy. A: After GB decompression by aspiration, the GB neck and/or Hartmann’s pouch can be pulled from the dorsal space. Hence, dissection can be performed as close to the GB as possible (red arrow) under adequate retractions (blue arrow); B: The rubbing of a bleeding vessel or oozing tissue (dotted arrow) by a button-shaped electrode with suction with a soft-coagulation system is a key technique for reliable hemostasis. During this hemostasis, subtle rotation of the electrode is important (red arrow); C: An elastic thread is never ligated directly; D: Clips are positioned to establish angular separation; E: A clip should be applied with the tip extending beyond the duct or vessels (red arrow); F: If the CD is too thick, loop ligation or a laparoscopic stapler can be chosen, under adequate retractions (blue arrows); G: Laparoscopic port penetrates abdominal wall at right angle (dotted arrow). A drain pathway through the abdominal wall is remade from the same skin incision (red arrow), to make the best drain placement (green arrow); H: A detached observer may be an actual solution for prevention of misidentification during LC. CD: Cystic duct; GB: Gallbladder; IC: Infundibulum-cystic duct; LC: Laparoscopic cholecystectomy.