Wide opening of calot’s triangle as the initial step- a safe alternative to standard procedure in laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is associated with relatively high risk of biliary injury, if not controlled can prove counterproductive to the benefits of minimal invasive surgery. This injury can be avoided by wide opening of calot’s triangle as the initial step. Method:  The procedure is done in 3steps. First step initial dissection in anatomical space flush with gall bladder wall. The posterior gallbladder peritoneum is divided first followed by anterior gallbladder peritoneum. The neck is then retracted upwards and downwards to facilitate section of fibrous tissue,at a distance from both the liver and cystic duct and artery, until calot’s triangle is widely opened. Second step is pulling of cystic duct and artery perpendicular to the CBD and dissecting them safely at distance from CBD, followed by clipping of cystic artery and cystic duct. Finally the fundus and body of the gallbladder are detached from liver. Results: Laparoscopic cholecystectomy was done by this method in 200 patients. The conversion rate was 4% and there was no bile duct injury. Discussion: These techniques avoid the bile duct and vascular injuries and helps to detect the anatomical abnormalities.