A novel technique of gall bladder splitting and extraction for thick-walled gall bladder and large stones in laparoscopic cholecystectomy

INTRODUCTION: The exact techniques for the extraction of thick-walled gall bladder and large calculus during laparoscopic cholecystectomy are not well described. This may require to dilate the port site or to enlarge the incision size, which has its own complications. PATIENTS AND METHODS: This is a description of a simple technique that helps in easy extraction of the thick-walled gall bladder and large stone more than 1 cm during laparoscopic cholecystectomy. These cases may require to dilate the port site or to enlarge the incision size, which can lead to increased operating time, more post-operative pain, increased port site hernia and infection risk. In this technique, gall bladder is longitudinally split along its long axis and large calculus, if present, is crushed in the endobag. This endobag with specimen can be removed easily from the 1 cm port site without need for the port site dilatation. RESULTS: We have employed 'longitudinal gall bladder splitting Technique' in around 245 cases of laparoscopic cholecystectomy operated in the past 5 years. Only three cases of port site infection and no cases of port site hernia were noted in this study. Ease of extraction by surgeons was rated as 9.6 on a scale of 1-10. CONCLUSION: 'Longitudinal gall bladder splitting Technique' is a simple and easily reproducible technique used for the extraction of thick-walled gall bladder and large calculus which reduces complications and makes it easy for the surgeon.