Laparoscopic partial cholecystectomy from the fundus downward using a combination of pneumoperitoneum and the abdominal wall-lift method in complicated cholelithiasis

To safely and reliably perform laparoscopic cholecystectomy in complicated cholelithiasis, we designed a method of initially resecting the anterior wall of the fundus and body from the fundus downward, fully dissecting the neck of the gall bladder from the liver bed, and finally dissecting the cystic duct and artery. This method differs from routine laparoscopic cholecystectomy in that the cystic duct is dissected first, and cholecystectomy is performed from the neck upward. In addition, to preventing inadequacy of the operative field, because of repeated suction, both the pneumoperitoneum and an abdominal wall-lift method are utilized. Our operation procedure makes it possible to perform complicated cholelithiasis safely during laparoscopic surgery.