FUNDUS-FIRST LAPAROSCOPIC CHOLECYSTECTOMY

Dr. C. N. Tang
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Fundus-first cholecystectomy has been frequently adopted in the era of open surgery. The technique can be applied to laparoscopic cholecystectomy in situations like marked inflammation and distorted anatomy at calot’s triangle where dissection from gallbladder fundus down to T-junction can avoid inadvertent bile duct injury. The trick is to leave part of the peritoneum at the liver side for cephalic retraction. Together with effective ultrasonic dissector, the gallbladder can be separated from the gallbladder fossa with minimal blood loss. It is important to milk the cystic duct with atraumatic forceps before applying ligature so as to prevent retained stone in the stump or stone migration into common bile duct.