Laparoscopic cholecystectomy facilitated by hydrodissection

Abstract

Hydrodissection has been used in the past in open cholecystectomy to facilitate dissection in difficult cases. Injection of 50 mL of saline, with a laparoscopic cyst aspiration needle during laparoscopic cholecystectomy between the gallbladder and the liver, causes an edematous area 1-1.5 cm thick between the gallbladder and the liver. This allows dissection to be carried out prograde and retrograde with less bleeding and a much smaller chance of gallbladder perforation and the escape of stones. One hundred and thirty-three laparoscopic cholecystectomies (LC) utilizing hydrodissection were compared to 48 historical controls (HC), comparing blood loss, stone spillage, and dissection time. Blood loss was on average less than 5 mL in the LC group and 56 mL in the HC. One case of minor biliary spillage occurred in the LC group and 11 gallbladder perforations in the HC group. Time taken for the dissection was 6.4 minutes for LC and 16 minutes for HC. Laparoscopic hydrodissection was accompanied by less bleeding, fewer incidents of gallbladder damage and stone spilling, and a much faster dissection time. It can also be performed prograde, which is helpful in liver cirrhosis.