Technique of transcylindrical gas-free cholecystectomy

Figure 4 View through the cylinder during surgery. The Hartmann Pouch is grasped with tissue forceps. Fat has been carefully dissected away using peanut gauze, as in conventional open surgery. The cystic duct, once clearly identified, is surrounded by using a right angle dissector. At this time, the surgeon and assistant must agree on the identity of the visible anatomic structures. The operation is carried out using reusable conventional open surgical instruments, the only exception being a disposable clip applier.