Protocol for laparoscopic cholecystectomy: Is it rocket science?

Tomohide Hori, Fumitaka Oike, Hiroaki Furuyama, Takafumi Machimoto, Yoshio Kadokawa, Toshiyuki Hata, Shigeru Kato, Daiki Yasukawa, Yuki Aisu, Maho Sasaki, Yusuke Kimura, Yuichiro Takamatsu, Masato Naito, Masaya Nakauchi, Takahiro Tanaka, Daigo Gunji, Kiyokuni Nakamura, Kiyoko Sato, Masahiro Mizuno, Taku IidaShintaro Yagi, Shinji Uemoto, Tsunehiro Yoshimura

Research output: Contribution to journalReview articlepeer-review

21 Citations (Scopus)


Laparoscopic cholecystectomy (LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety (CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations. Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC: (1) consideration that a high level of experience alone is not enough; (2) recognition of the plateau involving the common hepatic duct and hepatic hilum; (3) blunt dissection until CVS exposure; (4) Calot's triangle clearance in the overhead view; (5) Calot's triangle clearance in the view from underneath; (6) dissection of the posterior right side of Calot's triangle; (7) removal of the gallbladder body; and (8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

Original languageEnglish
Pages (from-to)10287-10303
Number of pages17
JournalWorld Journal of Gastroenterology
Issue number47
Publication statusPublished - 21-12-2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology


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