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The
following description represents one method for performing
laparoscopic cholecystectomy. Any suggestion that other
techniques are less desirable is not implied.
Phase 1: Exposing the Cystic Duct and
Artery
The most lateral accessory cannula is utilized to grasp the
fundus of the gallbladder and elevate it over the anterior edge
of the liver by progressive traction. Either a smooth or toothed
grasper may be used for this purpose depending on the thickness
of the gallbladder wall and associated edema. The infundibulum,
or Hartmann’s pouch, is pulled upward using a second grasper
placed through the remaining accessory port. This exposes the
cystic duct and artery as well as the common bile duct. Constant
retraction and good exposure are critical to the success of the
operation. If a second assistant is unavailable, the handle of
the retracting instrument may be clamped to the skin of the
abdomen or onto the protective drapes. The patient is then
positioned in reverse Trendelenburg and tilted to his/her left.
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