Purpose: Bile duct injury is the most dreaded complication of laparoscopic cholecystectomy. Although the mechanisms of bile duct injuries during laparoscopic cholecystectomy are varied, the common denominator is failure to recognize the anatomy of Calot's triangle. To avoid the bile duct injury, we propose a technique for laparoscopic cholecystectomy that starts with wide opening of Calot's triangle.

Methods: We compared the laparoscopic cholecystectomy performed by wide opening of Calot's triangle with previous technique which is dissected cystic duct first. the technique of wide opening of Calot's triangle is followings; The posterior peritoneum of gallbladder is divided first, beginning on the gallbladder neck, which is retracted upwards. Thereafter, while retracting the gallbladder neck downward, the anterior peritoneum of gallbladder is divided, again beginning on the gallbladder neck at a distance from the liver. The gallbladder neck is then retracted upward and downward to facilitate dissection of the fibrous tissue in Calot's triangle until the triangle is widely opened. The cystic duct and cystic artery are pulled perpendicular to the commom bile duct and are dissected safely at a distance from the CBD. The fundus and body of the gallbladder are detached from the liver.

Results: Between the two techniques, there were no statistically significant differences in the operating time, the postoperative complications and bile duct injuries. However, frequencies of complications and bile duct injuries of new technique are more smaller than that of the previous technique.

Conclusion: The technique that starts with wide opening of Calot's triangle may be a safe procedure especially in the beginning stages of a surgeon's learning curve.

Keywords: Laparoscopy, cholecystectomy, Calot's triangle, Common duct injury