title: Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source: a modified technique.
abstract: BACKGROUND
  Over the last two decades, laparoscopic cholecystectomy has become the gold standard for treating cholecystolithiasis and an index operation for evaluation and assessment of laparoscopic surgical skills. Its wider application and continuous refinement have not been accompanied by a commensurate decrease in morbidity due to biliary, vascular, or visceral injuries. Use of an energy source, especially monopolar electrosurgery, has been identified as a culprit for many of these injuries. This study assessed the feasibility of performing laparoscopic cholecystectomy safely without using any energy source by taking advantage of the avascular anatomical planes.
  
  
  METHODS
  Patients attending the surgery clinic of our center who were candidates for a laparoscopic cholecystectomy were enrolled. Informed consent was obtained from each patient before the procedure. The study was approved by the Ethical Review Board of the hospital and was conducted as per GCP guidelines.
  
  
  RESULTS
  Between June 2005 and July 2006, 83 patients were enrolled. All patients underwent laparoscopic cholecystectomy without any energy source being used. There was no incidence of biliary, vascular, or visceral injury. All patients remained hemodynamically stable. There was no conversion or mortality. The hospital stay was 8-16 h. Patients were followed up by telephone for the first 48 hours and then by regular outpatient visits until they were well.
  
  
  CONCLUSIONS
  A safe laparoscopic cholecystectomy without using any energy source can be performed by following the proper anatomical footprint.
authors.affiliation: Department of General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India. endosurgeon@gmail.com
authors.forename: B B
authors.initials: BB
authors.lastname: Agarwal
authors.forename: Brij
authors.initials: B
authors.lastname: Agarwal
authors.forename: Manish
authors.initials: M
authors.lastname: Gupta
authors.forename: Sneh
authors.initials: S
authors.lastname: Agarwal
authors.forename: Krishan
authors.initials: K
authors.lastname: Mahajan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D041761:Cholecystolithiasis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D000267:Tissue Adhesions / Q000601:surgery