Reversed 5 pattern of diagnostic laparoscopy during laparoscopic cholecystectomy and its standardization

An attempt at standardization of the diagnostic laparoscopy (DL) procedure during laparoscopic cholecystectomy (LC) was undertaken by establishing a simple pattern and checking its applicability in 100 consecutive LCs. DL was performed following the reversed number 5 pattern, starting from the right upper quadrant and moving to the left upper quadrant, left flank, back to the right flank along the transverse colon, down to the pelvis, along the sigmoid to the left flank, and back to the right upper quadrant inspecting small bowel. DL was incomplete in 11 patients. Inspection lasted 6-12 minutes (operation time increase, 14%). Abnormalities were discovered in 38% of patients, diagnosis elucidated in 8%, intervention undertaken in 11%, and control or further treatment proposed in 33%, without morbidity and mortality. The reversed 5 pattern of diagnostic laparoscopy is feasible and safe. It can be routinely done during LC in the general hospital setting. Standardization of diagnostic laparoscopy during laparoscopic cholecystectomy seems necessary for early disclosure of visible disorders and for medicolegal purposes.