TRACTION INJURY TO THE LIVER DURING LAPAROSCOPIC CHOLECYSTECTOMY

We describe an intraoperative complication of laparoscopic cholecystec tomy and make recommendations to avoid its occurrence. We describe a c ase in which the liver was lacerated during a routine laparoscopic cho lecystectomy. The laceration occurred when the gallbladder was retract ed into the suprahepatic space, causing a traction injury of the quadr ate lobe, 2 cm lateral to the falciform ligament. The placement of the epigastric trocar through the falciform ligament fixed the liver to t he abdominal wall, facilitating the injury. When placing the epigastri c trocar, care should be taken to avoid placement through the falcifor m ligament. If this is not possible, retraction of the gallbladder int o the suprahepatic space should be accomplished while observing the li ver edge. If the liver edge seems to be under tension, division of the falciform ligament to allow for easy retraction of the liver is recom mended.