The difficult gallbladder: technical tips for laparoscopic cholecystectomy

Conversion of laparoscopic cholecystectomy to laparotomy may increase postoperative complications and convalescence and should therefore be avoided when possible. The authors present three technical tips that may prevent unnecessary conversion to open procedure (suspension sutures in the gallbladder, use of the Endo Paddle Retract (United States Surgical Corp., Norwalk, CT, USA) to depress abdominal viscera, and subtotal cholecystectomy). These methods may be used in situations in which there is no operative risk for complications, such as bile duct injury, but technical aspects of the operation normally would have resulted in conversion to laparotomy.