Dome down Laparosonic Cholecystectomy

Background and Aims: In cases of cholecystitis or other difficult situations conversion to laparotomy may be necessary. Furthermore, some cases of bile duct injury may be caused by anatomical variations and/or injuries caused by electrocautery. A new laparoscopic technique using a fundus-first technique with ultrasonic dissection (“dome down laparosonic cholecystectomy”) may potentially solve these problems.Material and Methods: Twenty non-selected and consecutive patients with gallstone disease had laparoscopic cholecystectomy by the laparosonic dome down technique. Effect parameters were operative findings, duration of surgery and clinical course.Results: Six patients had fibrotic chronic cholecystitis and one had acute cholecystitis. Three patients had intraoperative cholangiography because of elevated liver enzymes. All operations were completed by the intended laparosonic dome down technique. Median duration of surgery in the 20 patients was 35 minutes (range 20–60). Median duration of surgery in the first 5 patients was 55 minutes (35–60), and in the last 15 patients it was 30 minutes (20–50). All patients had uneventful clinical courses with median hospital stay of 0 days (0–1).Conclusions: The technique was easy to learn and this new operative technique seems promising especially in cases of inflammation or fibrosis.