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Updated: Feb 21, 2026

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
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Fundus-first laparoscopic cholecystectomy

I G Martin1, S P Dexter, J Marton

  • 1Leeds Institute for Minimally Invasive Therapy, Division of Surgery, General Infirmary at Leeds, UK.

Surgical Endoscopy
|February 1, 1995
PubMed
Summary
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Fundus-first dissection with liver retraction is a safe laparoscopic cholecystectomy technique. This approach minimizes risks in difficult cases, offering safety and versatility comparable to open surgery.

Area of Science:

  • Surgical Techniques
  • Minimally Invasive Surgery
  • Gastrointestinal Surgery

Background:

  • Fundus-first dissection is a recognized safe method for difficult open cholecystectomy.
  • Minimizing damage to Calot's triangle structures is crucial in gallbladder removal.

Purpose of the Study:

  • To report the routine use of liver retractors and fundus-first dissection in laparoscopic cholecystectomy (LC).
  • To evaluate the safety and efficacy of this technique as an alternative to existing methods.

Main Methods:

  • The study involved 53 patients undergoing LC using liver retraction and fundus-first dissection.
  • Patient characteristics included acute admissions, adhesions, and prior abdominal incisions.

Main Results:

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  • The procedure was successful in 52 patients (98%), with one conversion to open surgery due to adhesions.
  • No mortality was observed; two complications included persistent pain and bile leakage.
  • Median operative time was 90 minutes.

Conclusions:

  • Liver retraction and fundus-first dissection can be safely applied to laparoscopic cholecystectomy.
  • This technique extends the safety and versatility of open surgery principles to the laparoscopic approach.