PMC4275857_01
Intraoperative image of the shrunken stone gallbladder.
gr2.jpg
PMC4275857_01_gr2.jpg
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After establishment of a pneumoperitoneum and installation of all four ports, a shrunk gallbladder was found [Fig. 2].
Attempt of the "critical view of safety" - only one structure entering the gallbladder can be clearly identified.
gr3.jpg
PMC4275857_01_gr3.jpg
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First, the gallbladder was grasped in the usual way at the fundus and pulled into the right upper abdomen, followed by dissection of the triangle of Calot [Fig. 3].
Dissection of the gallbladder from the gallbladder bed.
gr4.jpg
PMC4275857_01_gr4.jpg
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Despite adequate preparation and removal of all fatty and fibrose tissue only one structure entering the gallbladder was identified [Fig. 4].
"Critical view of safety" - all structures (cystic duct, common bile duct) can be unequivocally identified. The original wrong preparation site is marked on the right.
gr5.jpg
PMC4275857_01_gr5.jpg
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To provide clear anatomical conditions, the gall bladder was entirely dissected from its bed in a 'fundus first'-approach [Fig. 5].