title: A new technique for laparoscopic cholecystectomy--retrograde laparoscopic cholecystectomy: an analysis of 81 cases.
abstract: OBJECTIVE
  A new technique of laparoscopic cholecystectomy is presented here. This new method, retrograde laparoscopic cholecystectomy (RLC) from fundus to cystic duct downward, may have advantages when exposure of the cystic duct and the common duct are difficult and therefore hazardous.
  
  
  METHODS
  We carried out laparoscopic cholecystectomy in 173 patients; RLC was performed in 81, The operative procedure is as follows: first, the cystic duct and artery are exposed at the junction of the ampulla. The cystic duct is clipped, and the artery is divided. Removal of the gallbladder is then started from the fundus to cystic duct downward. After the gallbladder has been dissected from the liver bed, the cystic duct is double-clipped and divided. This approach provides better visualization of the gallbladder, cystic duct, and common duct, with less chance of common duct injury, due to clear identification of the ductal system, without the need for intraoperative cholangiography.
  
  
  RESULTS
  Eighty-one RLCs were performed without severe complications, either immediate or late. The mean operating time was 23 minutes shorter in RLC than in the usual laparoscopic cholecystectomy, because intraoperative cholangiography was used much less often.
  
  
  CONCLUSIONS
  RLC appears to be a safe procedure, and does not affect the conventional method.
authors.affiliation: Second Dept. of Surgery, Asahikawa Medical College, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: S
authors.initials: S
authors.lastname: Kasai
authors.forename: M
authors.initials: M
authors.lastname: Matsuda
authors.forename: K
authors.initials: K
authors.lastname: Onodera
authors.forename: J
authors.initials: J
authors.lastname: Kato
authors.forename: M
authors.initials: M
authors.lastname: Imai
authors.forename: M
authors.initials: M
authors.lastname: Mito
authors.forename: T
authors.initials: T
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D001158:Arteries / Q000601:surgery; D001646:Bile; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery; D003135:Common Bile Duct / Q000601:surgery; D003549:Cystic Duct / Q000601:surgery; D004210:Dissection; D004322:Drainage; D005260:Female; D005704:Gallbladder / Q000098:blood supply / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D012449:Safety; D013997:Time Factors