Laparoscopic Management of Difficult Cholecystectomy

Medicine is an ever changing art and needs to be shared with the progeny. Since the advent of laparoscopy, a new beginning started in the art of surgical craft. Many innovations and technical modifications are on the way for the satisfaction of the patient and the surgeon dealing with minimal access procedures. Laparoscopic cholecystectomy has revolutionized the whole globe and does not need any special mention. At the beginning surgeons would feel comfortable dealing with simple gallbladders but with the increase in expertise and introduction of newer armamentarium, difficult gallbladders are being subsequently dealt with. As of now, laparoscopic cholecystectomy can safely be declared as the gold standard for dealing with any kind of benign gallbladder disorder. However, before going to deal with the inflamed gallbladders; the skill of the surgeon, experience in laparoscopic techniques and thorough knowledge of risk factors are collectively important for a safe outcome. Even in the present era, the laparoscopic surgeon, amidst of such a substantial advance in laparoscopy, should have low threshold for conversion to open technique in case of difficulty. We strongly believe, from the experience we carry in dealing with these inflamed gallbladders, that every gallbladder is a book in itself which needs to be read time and again for a better and a safe outcome. Looking at the literature, the difficult thing to understand is to define the word ‘difficult gallbladder.’ However, we believe difficulty is a relative term and there are certain general principles that need to be followed before embarking on laparoscopic cholecystectomy. The aim of the operating surgeon should not only be giving the benefits of minimal access surgery but also avoiding the operative complications and lessen the postoperative morbidity.