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Related Experiment Videos

Fundus-first laparoscopic cholecystectomy.

S Mahmud1, M Masaud, K Canna

  • 1Upper Gastrointestinal and Laparoscopic Service, Department of Surgery, Vale of Leven District Hospital, Dunbartonshire, Scotland, G83 OUA, UK.

Surgical Endoscopy
|April 25, 2002
PubMed
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Fundus-first laparoscopic cholecystectomy (FFLC) is a safe and feasible approach for difficult cases. This technique effectively reduces the conversion rate in challenging laparoscopic surgeries.

Area of Science:

  • Minimally Invasive Surgery
  • Gastrointestinal Surgery
  • Surgical Techniques

Background:

  • Fundus-first dissection (FFD) is established for difficult open cholecystectomies.
  • FFD is underutilized in laparoscopic cholecystectomy (LC) due to retraction and adhesion challenges.
  • Obscured cystic pedicles often lead to conversion in standard LC.

Purpose of the Study:

  • To evaluate indications and technical aspects of FFD in difficult LC.
  • To assess the safety and impact on conversion rates of FFLC.
  • To analyze FFLC in challenging laparoscopic cholecystectomy cases.

Main Methods:

  • Prospective analysis of FFLC cases with difficult cystic pedicles.
  • Review of video recordings and procedural data.

Related Experiment Videos

  • Assessment of safety and conversion rates.

    • Main Results:

    • FFLC was used in 35 of 710 LCs (5%), primarily for dense adhesions, stones, or difficult anatomy.
    • Successful FFLC completion in 31 cases, with conversion needed in 4 (11%).
    • No operative or technique-related complications were reported.

    Conclusions:

    • Fundus-first laparoscopic cholecystectomy is a feasible and safe option for difficult cystic pedicles.
    • FFLC significantly reduced the conversion rate in this series.
    • Prompt conversion or subtotal cholecystectomy is advised if anatomy remains unclear.