Triangle of safety technique: a new approach to laparoscopic cholecystectomy.
BACKGROUNDS AND STUDY AIMS: Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy (LC). Misidentification of the CBD during dissection of the Calot's triangle can lead to such injuries. The aim of the authors in this study is to present a new safe triangle of dissection.


METHODS
501 patients under went LC in the following approach; The cystic artery is identified and mobilized from the gall bladder (GB) medial wall down towards the cystic duct which would simultaneously divide the medial GB peritoneal attachment. This is then followed by dividing the lateral peritoneal attachment. The GB will be unfolded and the borders of the triangle of safety (TST) are achieved: cystic artery medially, cystic duct laterally and the gallbladder wall superiorly. The floor of the triangle is then divided to delineate both cystic duct and artery in an area relatively far from CBD.


RESULTS
There were little significant immediate or delayed complications. The mean operating time was 68 minutes, nearly equivalent to the conventional method.


CONCLUSIONS
Dissection at TST appears to be a safe procedure which clearly demonstrates the cystic duct and may help to reduce the CBD injuries.
Almutairi
Abdulrahman Faraj
AF
Department of Surgery, Farwaniya Hospital, 81002 Farwaniya, Kuwait.
Hussain
Yousef A M S
YA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D004564:Electrocoagulation; D005260:Female; D005705:Gallbladder Diseases / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult