Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy.

The incidence of bile duct injury in laparoscopic cholecystectomy is 0.3% to 1.0%. This is higher than the incidence reported for open cholecystectomy (i.e., 0.1-0.2%), and the surgeons all over the world are relentlessly trying to find the ways and means to lower this incidence. Various operating strategies, techniques, and instrumentations such as the 0 degrees telescope, intraoperative cholangiogram, hydrodissection, and peanut gauze dissection have been claimed by various authors to minimize the risk of bile duct injury during cholecystectomy. However, the surgical fraternity agrees that there has been no substitute for meticulous dissection and display of various vital structures near the common bile duct. The authors describe seven anatomic landmarks encountered during laparoscopic cholecystectomy that assist in safe dissection to prevent bile duct and vascular injury. On the basis of their experience, they believe that if surgeons adhere to these landmarks, excellent results can be achieved.