Three Cases of Laparoscopic Cholecystectomy by Double Scope Method

Katsunari Takifuji, Hiroshi Tanimura, Yugo Nagai, Hideo Kashiwagi, Kazuhisa Uchiyama, Yoshihiro Nakatani

Department of Gastroenterological Surgery, Wakayama Medical College

An important difference between laparoscopic cholecystectomy and open cholecystectomy is that laparoscopic cholecystectomy must be done under two dimensions and one visual field. Therefore, biliary tract injuries can occur. We usually insert the 5th trocar between the 10 mm trocar below the xyphoid processus and the 5 mm trocar on the midclavicular line, and insert another 5 mm laparoscope. Cholecystectomy is carried out using the two scopes. The laparoscope at the umbilicus is necessary to guide the instruments when they are taken in and out. The usefulness of the double scope method is as follows. (1) We can observe the Calot triangle from the same direction at laparotomy with the second laparoscope. The common bile duct and the common hepatic duct are easily confirmed. (2) We can identify the cystic duct and the cystic artery from two directions and prevent clipping and dissecting excessive tissues. (3) We can dicide on the correct point to clip the cystic duct from two directions. (4) We can ablate safely omental and duodenal adhesions to the liver through front vision by the second laparoscope.

Key words
laparoscopic cholecystectomy, double scope method, bile duct injury

Reprint requests
Katsunari Takifuji Department of Gastroenterological Surgery, Wakayama Medical College
27 Shichibancho Wakayama City, 640 JAPAN

Accepted
June 14, 1993

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