CONFIRMATION OF A SAFETY ZONE BY INTRAOPERATIVE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Background: Creating a ''safety zone'' during laparoscopic cholecystec tomy is defined as dissection of the cystic duct as close as possible to the gallbladder. Methods: In 29 out of 802 cases in which laparosco pic cholecystectomy was difficult to perform due to uncertainty about the orientation of Calot's triangle, intraoperative cholangiography wa s performed, using a titanium clip as a marker that designated the saf ety zone, The distance between the clip and the common hepatic duct or the common bile duct could be determined by evaluation of two intraop erative cholangiograms taken in different orientation. Results: If the clip was located in the safety zone, and was distant from the common hepatic duct or common bile duct, the safety of preparation around the clip was ensured. No complication was encountered in these cases with this method. Eventually, no biliary tract injury was experienced, and the overall conversion rate to open cholecystectomy was only 0.4% (3 of 802 consecutive cases). Conclusions: This method of confirming the safety zone by intraoperative cholangiography is a useful procedure fo r avoiding inadvertent injury to the biliary tract.