Copyright ©The Author(s) 2016.
World J Gastroenterol. Dec 21, 2016; 22(47): 10287-10303
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10287
Table 1 Mandatory protocol to avoid unexpected injuries during laparoscopic cholecystectomy
Consideration that a high level of experience alone is not adequate for successful laparoscopic cholecystectomy
Biliary injuries are principally caused by misperception, not from insufficient skill, lack of knowledge, or misjudgment
Misidentification is the result of failure to conclusively identify the cystic structures and is secondary to the surgeons’ assumptions during LC
Recognition of the plateau involving the CHD and hepatic hilum
Stretch the hepatoduodenal ligament and confirm the left sagittal fissure
A U-shaped line is visually traced from the round ligament of the liver to the left side of the GB
The bottom plateau of this U-shaped line necessarily involves the CHD and hepatic hilum
Blunt dissection until CVS exposure
During clearance of Calot’s triangle, the dissectable/cuttable layer should be traced as close to the GB and CD as possible
Tissue dissection and membrane cutting should be extended from the apparent side, not from the unknown side
Never use any sealing devices until CVS exposure
Calot’s triangle clearance in the overhead view
Hartmann’s pouch should be pulled laterally and inferiorly to open the anterior left side of Calot’s triangle
A wider angle between the CD and CHD is created
The anterior left side of Calot’s triangle is exposed and dissected
Calot’s triangle clearance in the view from underneath
The hepatorenal fossa is widely dilated, and Hartmann’s pouch is confirmed.
Superior and medial traction of the GB infundibulum or Hartmann’s pouch is performed
The S-like curve on Hartmann’s pouch, GB infundibulum, IC junction, and CD is confirmed
The IC junction is confirmed as an inverted V shape due to superior and medial traction of the GB
Dissection of posterior right side of Calot’s triangle in the rightward and upward view
Cutline of membrane is made to the GB body at a point adequately distant from Rouviere’s sulcus
The posterior right side of Calot’s triangle is exposed and dissected
The GB wall and fatty fissure of Rouviere’s sulcus should be uncoupled
Dissectable tissue around the GB should never be followed into Rouviere’s sulcus
Removal of half to two-thirds of GB body from the LB
Half to approximately two-thirds of the GB body is removed from the LB at the CVS exposure
Positive accomplishment of the CVS exposure
Only two cystic structures should be seen entering the GB