Difficult laparoscopic cholecystectomy in acute cholecystitis: use of 'finger port', a new approach.

BACKGROUND: Adhesions in acute cholecystitis tax even the more experienced operator during laparoscopic cholecystectomy. Blunt and sharp dissection, electrocautery, laser, hydrodissection, and ultrasonic dissection may all have their limitations. Thus there is a need for an alternative and more effective method.
METHOD: Laparoscopic cholecystectomy was carried out in 281 patients with acute cholecystitis. Separation of the gallbladder from the adherent structures was carried out in 13 patients, using the forefinger of the left hand introduced through the right hypochondrial port. In two patients a second finger was introduced through the epigastric port.
RESULTS: The mean time required for the dissection was 7.9 minutes. Finger dissection failed in three patients because of dense adhesions on a high subcostal position of the gallbladder. DISCUSSION: Finger dissection is easy, fast, and limits injury because of the direct vision and tactile sensation, which are missing in other methods of laparoscopic dissection.