A narrative review about difficult laparoscopic cholecystectomy: technical tips

Background: Laparoscopic cholecystectomy (LC) is the most practiced procedure in general surgery worldwide. It is nowadays the optimum surgical procedure for symptomatic gallbladder lithiasis. Nevertheless, it should not be underestimated since vascular and biliary duct injuries are not uncommon, with devastating consequences. This study aimed to advise the best surgical technical approach for LC according to the intraoperative situation to avoid accidental anatomical structures injuries. Methods: A traditional narrative literature search for articles published up to December 2021 was performed using the most common search engines (PubMed, Web of Science, Google Scholar). The search strategy utilized in all databases included the combination of the keywords: "laparoscopic cholecystectomy", "difficult cholecystectomy", "acute cholecystitis", "prevention bile duct injuries", "safe cholecystectomy". No restrictions were applied to the language of the publication if an English version of the article was available. Key Content and Findings: Difficult laparoscopic cholecystectomy (DLC) is a distressing condition. Its definition is not well established and may vary according to the surgeon's experience. Several techniques have been proposed to minimize the bile duct or hepatic injury risk during the challenging cholecystectomy. Conclusions: Although LC is nowadays the optimum surgical procedure for symptomatic gallbladder lithiasis, it should not be underestimated since vascular and biliary duct injuries are very morbid, significantly increase care costs, and often lead to litigations.