Gripping the difficult gall bladder during laparoscopic cholecystectomy.

Grasping a tense, inflamed gall bladder during laparoscopic cholecystectomy for acute cholecystitis is often a problem. Although many surgeons have developed techniques to deal with this, the published work lacks information about how to manage this problem. To collate experience about how to deal with this we interviewed 20 experienced Australian surgeons and compiled a repertoire of tactics that might help deal with this clinical situation. Most surgeons indicated that they deflated the gall bladder using a needle and suction as a preliminary step. Most respondents also described the use of a specific type of forceps for the task. Various manoeuvres, such as displacement of the gall bladder with forceps, dislodging an impacted stone to make it easier to grasp, the use of a retraction suture through the gall bladder were described. The various tactics are summarized in the paper. A range of strategies applied by experienced surgeons for the task of gripping a difficult gall bladder has been documented in this paper. The variety of approaches suggests that surgeons should be prepared to flexibly apply different approaches to this task.