Subtotal Cholecystectomy - Type 1B
Case scenario
A type 1B subtotal cholecystectomy would be considered a situation where the cystic duct is closed and the backwall left intact to prevent injury to the bile duct and portal structures.
Standard laparoscopic cholecystectomy procedures follow the classic approach to visualize Calot's triangle. Under certain circumstances, the dissection may be difficult and even dangerous.
Utilizing anatomic landmarks such as the Sulcus of Rouvier and the hilar plate, the 'Top-Around approach' may be attempted to safely visualize the cystic duct and artery.
In severe circumstances, the decision to change the surgical plan to a subtotal cholecystectomy should be considered as a valid alternative approach.
