Posterior infundibular dissection: safety first in laparoscopic cholecystectomy

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Minimally Invasive Procedures

Background:

• Laparoscopic cholecystectomy (LC) carries a risk of bile duct injuries (BDI).
• Existing safety methods include intra-operative cholangiography, indocyanine green (ICG) with infrared imaging, and critical view of safety (CVS).
• A novel approach, posterior infundibular dissection, is introduced to further enhance LC safety.

Purpose of the Study:

• To describe a posterior infundibular dissection technique for laparoscopic cholecystectomy (LC).
• To report the safety and efficacy of this approach in preventing bile duct injuries (BDI).

Main Methods:

• Detailed description of the posterior infundibular dissection as the initial operative maneuver in LC.
• Routine application of the technique over ten years, with a review of 1402 cases.
• Experience developed over 30 years of laparoscopic cholecystectomy.

Main Results:

• 1402 LCs were performed using the posterior infundibular approach between January 2010 and December 2019.
• 80.3% of operations were elective, and 19.97% were emergent.
• Zero bile duct injuries (BDI) were reported; one conversion to open surgery and four bile leaks managed with ERCP occurred.

Conclusions:

• Initial posterior mobilization of the gallbladder infundibulum enhances laparoscopic cholecystectomy (LC) safety.
• This technique minimizes the need for extensive medial and cephalad dissection, reducing the risk of bile duct injury (BDI).
• The posterior infundibular approach can reduce BDI risk to null and complements other safety measures.