International Surgery Journal | February 2021 | Vol 8 | Issue 2 Page 773 International Surgery Journal Manangi M et al. Int Surg J. 2021 Feb;8(2):773-775 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Commentary Controlled traction-a key for safe laparoscopic cholecystectomy Mallikarjuna Manangi 1 , Dharini Dharini 2 , Tanvi Sunil Kumar 1 , Ramya M. Vishweshwara 1 * INTRODUCTION Semm, in 1980, performed the first successful laparoscopic surgery to perform an appendicectomy. 1 In 1985, Eric Muhe performed the first laparoscopic cholecystectomy. 2 Laparoscopic cholecystectomy is one of the surgeries which propelled the laparoscopic era into the highly evolved field that it is now. In 1992, the national institute of health declared that the gold standard for treatment of symptomatic cholelithiasis is laparoscopic cholecystectomy. 3 The laparoscopic cholecystectomy technique has seen numerous changes over the decades. Each surgeon titrates the surgical technique to suit personal preference. One of the troublesome steps of laparoscopic cholecystectomy is dissection of the gall bladder from the liver bed. We describe a unique method which is easy to perform at the same time gives excellent exposure. STANDARD PROCEDURE The patient is placed supine on the operating table with the surgeon standing at the patient’s left side. The pneumoperitoneum is created with carbon dioxide gas, either with an open technique or by closed needle technique. The laparoscope with the attached video camera is passed through the umbilical port and the abdomen inspected. Three additional ports are placed under direct vision. A 10-mm port is placed in the epigastrium, a 5-mm port in the middle of the clavicular line, and a 5-mm port in the right flank, in line with the gallbladder fundus. Through the lateral-most port, a grasper is used to grasp the gallbladder fundus. It is retracted over the liver edge upward and towards the patient’s right shoulder to expose the proximal gallbladder and the hilar area. Exposure of the hilar area may be facilitated by placing the patient in reverse Trendelenburg position with slight tilting of the table to bring the right side up. Through the midclavicular port a second grasper is used to grasp the gallbladder infundibulum and retract it laterally to expose the triangle of Calot. Most of the dissection is carried out through the ABSTRACT Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures performed. The technique of LC has witnessed numerous modifications according to surgeon’s preferences to improve the ergonomics, surgical ease, safety and outcome. Dissection of the gall bladder from the liver bed is one of the troublesome steps. We aim to describe a unique method which is technically easy to perform and provides excellent exposure as well. A total of 206 patients underwent laparoscopic cholecystectomy at our Institute over a year from January 2017 to 2018. The technique of torquing the gallbladder to dissect it off its bed is surgeon friendly with advantages of instrumentation and visualization. Keywords: Laparoscopic cholecystectomy, Technique, Dissection from liver bed, Safe Cholecystectomy 1 Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India 2 Department of Plastic and Reconstructive Surgery, Vardhaman Mahaveer Medical College, New Delhi, India Received: 08 November 2020 Revised: 12 January 2021 Accepted: 15 January 2021 *Correspondence: Dr. Ramya M. Vishweshwara, E-mail: romidocmpl@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20210404