Hand-assisted laparoscopic surgery for complex gallstone disease: A report of five cases

Figure 1 Position of the Trocars and the hand. A: Camera port; B: working port; C: hand insertion; D: additional port.

Figure 2 Preoperative MRCP demonstrated compression of the CHD by a large stone with dilation of intrahepatic bile duct characteristic of Mirizzi’s syndrome (Case 4).

Figure 3 Causes of hand-assisted laparoscopic surgery. A: One 1.0-cm stone impacted in the infundibulum fused with the CHD, impossible to remove with laparoscopic instruments; B: Using the intra-abdominal hand to facilitate such maneuvers as squeezing out of the stone (case 1); C: Compression of the CHD by one 2.5-cm stone; D: Identification and dissection of the obscured Calot triangle by the hand (case 4); E: A severely inflamed gallbladder with a neck stone caused obscured Calot’ triangle without jaundice (mimic Mirizzi syndrome, case 2).