title: Methods of safe laparoscopic cholecystectomy for left-sided (sinistroposition) gallbladder: A report of two cases and a review of safe techniques.
abstract: BACKGROUND
  Left-sided gallbladder is a rare anatomical variation. Usually it is discovered intra-operatively and is accompanied by anatomic variations that can prove quite challenging during laparoscopy.
  
  
  METHODS
  From a total of almost 3000 laparoscopic cholecystectomies performed in our institution, two cases of left sided gallbladder were unexpectantly identified intraoperatively. There were no indications for the ectopy preoperatively. In both cases modifications of the standard laparoscopic technique were mandatory. They were performed safely with no post-operative complications. Modifications consisted of transposition of the subxiphoid entry port and alteration in the direction of traction of the rest of the graspers. A review of the literature for methods of safe laparoscopic cholecystectomy was conducted.
  
  
  CONCLUSIONS
  The surgeon must be aware of the anatomic variances in the rare occasion of a left sided gallbladder, since preoperative diagnosis is very difficult.
  
  
  CONCLUSIONS
  Knowledge of potential hazards and modifications of laparoscopic technique is mandatory in order to avoid complications.
authors.affiliation: Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece. Electronic address: kosnastos@yahoo.gr.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Nastos
authors.affiliation: Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Vezakis
authors.affiliation: First Department of Radiology, School of Medicine, University of Athens, Aretaieion University Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papaconstantinou
authors.affiliation: Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Theodosopoulos
authors.affiliation: Second Department of Surgery, School of Medicine, University of Athens, Aretaieion University Hospital, 76 Vassilisis Sofia's Ave, 11528 Athens, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Koutoulidis
authors.affiliation: First Department of Radiology, School of Medicine, University of Athens, Aretaieion University Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Polymeneas
keywords: Cholecystectomy; Laparoscopic; Left-sided gallbladder; Safe; Systematic review; Technique