Laparoscopic cholecystectomy: semi-top-down technique

Laparoscopic cholecystectomy is the most common abdominal operation performed in the United States. Although the rates of biliary injury are low, they remain twice that of an open cholecystectomy. The infundibular-first approach to a laparoscopic cholecystectomy is the most common method for removing the gallbladder. It has visual advantages compared to a laparoscopic top-down approach, however there are inherent error traps that can be unavoidable with this technique. We propose a laparoscopic semi-top-down technique that has the visual advantages of an infundibular-first approach while keeping the safety advantages of a top-down approach.