Aspiration or Suture Traction of the GB

Surgical video case: difficult laparoscopic cholecystectomy, adhesions to the omentum, falciform ligament, anterior abdominal wall, and diaphragm. The GB is distended, and its wall is so thick that grasping it is impossible. The aspiration of the GB to achieve partial collapse aiming to grasp it is not ideal as you see here. That was recommended by some of our colleagues in the video of suture traction to retract the GB in a similar situation. Also, these trials to grasp an edematous thick wall GB carry the risk of breaking my instruments.

Here I take the opportunity to ask you about the ideal method for the classification of the difficulty of laparoscopic cholecystectomy. According to the total time of the procedure, the time of dissecting the Calot's triangle, the presence of congenital anomalies, the presence of adhesions, difficulty in dissecting the GB from the liver, the presence of bleeding, inflammation, the presence of abnormal anatomy.

Also, some difficulties are made by the surgeon as improper port placement, the use of malfunctioning instruments.

But here is another question about some cases that may be difficult for one surgeon but not for another one. So the establishment of a scoring system for difficult lap chole demands multicenteric worldwide research work.