Abstract
Laparoscopic cholecystectomy is difficult for severe cholecystitis or other anatomical variations. To avoid bile duct or liver injury, basic technique of cholecystomucoclasis (CM) is sometimes necessary. There are 3 approaches for CM. 1. fundus-first approach: This approach is usually used for open surgery. In difficult cases in which dissection cannot be started or continued safely in any direction, the fundus and body of gallbladder (GB) is excised and unroofed. The residual mucosa of GB on the liver bed is coagulated. The orifice of cystic duct is closed by manual suturing. 2. body-first approach: The mucosa of GB is sometimes lacerated easily because of severe inflammation. When the wall of GB was injured unexpectedly, it should be dissected from the hole lacerated. 3. neck-first approach: In cases with a short cystic duct, a transfixing suture should be applied for ligation instead of clipping. After the cutting of cystic duct, the orifice of GB in the neck can be seen. The wall of GB is started dissection from the orifice. Finally, it is important to make the hole of GB safely and start the unroofing for CM in laparoscopic surgery.
