title: Difficult laparoscopic cholecystectomy in acute cholecystitis: use of 'finger port', a new approach.
abstract: BACKGROUND
  Adhesions in acute cholecystitis tax even the more experienced operator during laparoscopic cholecystectomy. Blunt and sharp dissection, electrocautery, laser, hydrodissection, and ultrasonic dissection may all have their limitations. Thus there is a need for an alternative and more effective method.
  
  
  METHODS
  Laparoscopic cholecystectomy was carried out in 281 patients with acute cholecystitis. Separation of the gallbladder from the adherent structures was carried out in 13 patients, using the forefinger of the left hand introduced through the right hypochondrial port. In two patients a second finger was introduced through the epigastric port.
  
  
  RESULTS
  The mean time required for the dissection was 7.9 minutes. Finger dissection failed in three patients because of dense adhesions on a high subcostal position of the gallbladder.
  
  
  CONCLUSIONS
  Finger dissection is easy, fast, and limits injury because of the direct vision and tactile sensation, which are missing in other methods of laparoscopic dissection.
authors.affiliation: Department of Surgery, MLB Medical College, Jhansi, UP, India. sinha_rga@yahoo.com
authors.forename: R
authors.initials: R
authors.lastname: Sinha
authors.forename: N
authors.initials: N
authors.lastname: Sharma