Technik der laparoskopischen Cholezystektomie

A new technique for laparoscopic cholecystectomy is described which regards as far as possible the conventional approach to cholecystectomy. Positioning of the operating team is identical to normal cholecystectomy, and the surgeon is able to use both hands to operate since the camera is handled by the assistant. Dissection of the infundibulum is performed in the socalled "tease-and-tear" technique. The peritoneal layer is opened by coagulation. The cystic duct and artery are bluntly dissected by a commercially available dissector. Fat and connective tissue are gently torn off from both structures. After closure of cystic duct and artery by clips, the gallbladder is cut out by thermocoagulation. 178 operations were performed by 8 surgeons; mean duration of the operation was 60 min. A change to open cholecystectomy was necessary in 2.5%. Three complications occurred, requiring reoperation in one case of insufficiency of the cystic duct and another one with intestinal perforation. In the third case, bile leakage from an aberrant bile-duct occurred but dried up spontaneously after a few days. No death occurred nor were there any lesions of the common bile-duct. Conclusively, this new technique seems to be safe and simple to teach due to its approximity to the conventional technique and is recommended as a standard procedure.