Redefining safety in laparoscopic cholecystectomy: insights into the Madany’s triangle technique with a critical appraisal

Abstract Background Laparoscopic cholecystectomy (LC) carries a persistent risk of bile duct injury (BDI), partly due to the limitations of conventional anatomical landmarks such as Calot’s Triangle (CT) and the Critical View of Safety (CVS). These limitations become more pronounced in the presence of inflammation, adhesions, or anatomical variations. The Madany’s Triangle technique has been introduced as a novel dissection strategy to address these challenges by improving visualization and reducing the risk of injury. Objective To describe the principles, operative steps, and practical advantages of the Madany’s Triangle technique in LC, based on extensive clinical experience. Methods This experience-based technical note is derived from the senior author’s observations across hundreds of LC procedures. All insights were collected during routine surgical practice without formal statistical analysis, control groups, or comparative assessment. No patient identifiers were recorded, and no additional interventions beyond standard care were performed. Results/Experience The technique emphasizes early skeletonization of the proximal gallbladder, infundibulum, and cystic duct, combined with early scarification of the cystic artery. This creates a dynamic surgical window that enhances visualization of critical biliary structures, including the common bile duct. Controlled traction on Hartmann’s pouch provides dual-angle visualization from both right-sided and left-sided perspectives, reinforcing SAGES recommendations for safe LC. Surgeons applying this technique have reported clearer anatomical definition, greater confidence during dissection, and fewer intraoperative uncertainties. Conclusion The Madany’s Triangle technique offers a structured, safety-oriented dissection approach that may enhance outcomes in both routine and complex LC cases. Further research—particularly controlled clinical trials—is necessary to validate its effectiveness and to define its role relative to established methods such as CVS.