Top Around approach

Technique description

In all laparoscopic cholecystectomy, every effort should be made to fully dissect Calot's triangle and achieve the critical view of safety (CVS). However, under certain circumstances, the dissection may be difficult and even dangerous.

When further dissection in the presence of inflammation risks injury to porta structures, a safe alternative may be to dissect hartman's pouch along the edge of the gall bladder moving in a counter-clockwise direction, always staying above a line of safety between the sulcus of Rouviere and the hilar plate.

This approach helps to ensure that prior to removal, the only structures seen entering the gall bladder are the cystic duct and cystic artery, fulfilling the original intent of achieving the CVS through alternative means.

NEXT TIP: Line of Safety