Inferolateral retraction reduces the risk of thermal injury to biliary structures.
OBJECTIVE
Do various traction techniques significantly change the anatomic position during laparoscopic cholecystectomy?


METHODS
16 cadaveric liver specimens were dissected and measurements were taken between structures in the triangle of Calot. Measurements were taken while traction was placed on the infidubilum in the inferolateral, cephalad and anatomic positions. Thermal necrosis data was measured one week post-injury in a rat model for Non-contact Yag laser, Quartz, Sapphire tip, and electrocautery.


RESULTS
Inferolateral traction provided statistically significant increases in distance (P < 0.01) between the critical biliary structures. The increase in length by cephalad traction on the gallbladder was not statistically significant. Depth of necrosis for the devices were: cautery 1.03 mm, sapphire tip 0.63 mm, non-contact Yag laser 2.13 mm, and bare quartz tip laser 1.05 mm.


CONCLUSIONS
Inferolateral traction produced a statistically significant increase in distance between the critical biliary structures. This was not demonstrated with cephalad traction. We recommend avoiding thermal dissection in the Triangle of Calot due to the thermal devices necrosis depth in relation to the proximity of the biliary structures.
Linderman
C
C
Fairview Hospital Department of Surgery, Cleveland, OH 44111, USA.
Pratt
D
D
Petricevic
M
M
ReMine
S G
SG
D000818:Animals; D001652:Bile Ducts / Q000293:injuries*; D002102:Cadaver; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation*; D004210:Dissection; D004564:Electrocoagulation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015601:Injury Severity Score; D007834:Lasers / Q000009:adverse effects; D008099:Liver / Q000033:anatomy & histology*; D051381:Rats; D018570:Risk Assessment