BACK TO SERVICESSAFE LAPAROSCOPIC CHOLECYSTECTOMY

GALLBLADDER SURGERY

From symptomatic gallstones to acute inflammation, with systematic anatomical identification and safety strategies.

Medical author: Efstratios K. KouroumpasPage updated: August 30, 2026

CRITICAL VIEW OF SAFETYICG / NIRBAIL-OUT STRATEGY

EXPLORE THE PROCEDURES

ELIXIS · ADVANCED CARE

The goal is not simply removal — it is safe identification

Biliary anatomy is confirmed before division. When inflammation obscures planes, the strategy changes early.

SYMPTOMS

Symptoms that merit assessment

Many gallstones cause no symptoms. Temporary blockage of bile flow may cause biliary colic, while prolonged obstruction can lead to inflammation or other complications.

RIGHT UPPER PAIN

Pain in the right upper or central abdomen.

AFTER MEALS

Pain often follows a meal and may last from minutes to several hours.

TO BACK OR SHOULDER

Discomfort may travel to the back or right shoulder.

NAUSEA OR VOMITING

A pain episode may be accompanied by nausea or vomiting.

FEVER OR CHILLS

Fever or chills may indicate that inflammation has developed.

JAUNDICE

Yellow skin or eyes, dark urine and pale stools may indicate bile-duct obstruction.

Indigestion or bloating alone do not prove gallstone disease. Assessment combines history, examination, blood tests and usually ultrasound.

PROCEDURES

Procedures and safety techniques

These are different clinical scenarios; not every option is used in every patient.

01GALLSTONES

SYMPTOMATIC GALLSTONE DISEASE

Before surgery is recommended, the symptoms are assessed to confirm that gallstones are the likely cause.

WHEN IT MAY BE CONSIDERED: Biliary colic, gallstone complications or another established indication.
WHAT IT INVOLVES: Ultrasound, blood tests and common-duct assessment guide the appropriate plan.

02LAP CHOLE

LAPAROSCOPIC CHOLECYSTECTOMY

Removal of the gallbladder through small incisions for symptomatic stones.

WHEN IT MAY BE CONSIDERED: Symptomatic gallstones or a prior complication with a clear surgical indication.
WHAT IT INVOLVES: Safe dissection, control of the cystic duct and artery, and protected specimen extraction.

03CVS

CRITICAL VIEW OF SAFETY

Three defined anatomical criteria before dividing the cystic duct and artery.

WHEN IT MAY BE CONSIDERED: A core safety goal in standard laparoscopic cholecystectomy.
WHAT IT INVOLVES: All three criteria are required: the hepatocystic triangle is cleared of fat and fibrous tissue, the lower one third of the gallbladder is separated from the liver to expose the cystic plate, and two —and only two— structures are seen entering the gallbladder.

04ICG · NIR

ICG FLUORESCENCE CHOLANGIOGRAPHY

Intravenous ICG displays biliary anatomy with near-infrared imaging and no ionising radiation.

WHEN IT MAY BE CONSIDERED: Adjunctive mapping in selected laparoscopic procedures.
WHAT IT INVOLVES: The fluorescence view is alternated with white light; it supports but does not replace safe dissection and surgical judgement.

05ACUTE

ACUTE CHOLECYSTITIS SURGERY

Early laparoscopic treatment of an inflamed gallbladder when clinically appropriate.

WHEN IT MAY BE CONSIDERED: Acute inflammation confirmed by clinical, laboratory and imaging findings.
WHAT IT INVOLVES: Decompression when needed, careful dissection and early use of a safer bail-out strategy or conventional cholangiography when indicated.

06BAIL-OUT

SUBTOTAL CHOLECYSTECTOMY

A bail-out strategy when safe anatomical identification is not possible.

WHEN IT MAY BE CONSIDERED: Severe inflammation, fibrosis or hazardous anatomy in the hepatocystic triangle.
WHAT IT INVOLVES: The safely accessible gallbladder and reachable stones are removed; the remnant and cystic duct are managed according to the anatomy. Bile leak and retained-stone risks remain.

Conceptual anatomical artwork for general information — not a patient photograph or an exact representation of an operation.

PLANNING & SAFETY

Anatomy is confirmed before division

ICG and conventional cholangiography are distinct adjuncts. ICG uses no X-rays and does not reliably exclude common-duct stones; neither tool replaces the Critical View of Safety or surgical judgement.

TIME-OUT

A pause before division to confirm anatomy.

TWO STRUCTURES

Clear identification of cystic duct and artery.

IMAGING

ICG for adjunct anatomical mapping; conventional cholangiography when common-bile-duct imaging is needed.

BAIL-OUT

Early change of plan in hazardous anatomy.

QUESTIONS

FREQUENTLY ASKED QUESTIONS

Short answers before an individualised surgical assessment.

01Is a minimally invasive approach always possible?

No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.

02How long does recovery take?

Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.

03Is ICG fluoroscopy?

No. It uses near-infrared fluorescence rather than ionising radiation. Contraindications and the possibility of a rare reaction must still be checked.

CLINICAL EVIDENCE

The final choice is based on the clinical presentation, individual anatomy and current guidance.

01SAGES · Safe Cholecystectomy GuidelineCritical View of Safety and injury-prevention strategiesOFFICIAL SOURCE 02SAGES · Fluorescence-Guided SurgeryClinical guidance for ICG fluorescenceOFFICIAL SOURCE 03SAGES · Intraoperative CBD ImagingICG fluorescence and conventional X-ray cholangiographyOFFICIAL SOURCE 04NIDDK · GallstonesSymptoms of gallstones and complicationsOFFICIAL SOURCE

This content is educational and does not replace medical assessment. No technique is appropriate for everyone; benefits, risks and alternatives are discussed individually.

INDIVIDUALISED SURGICAL ASSESSMENT

The right operation starts with the right indication.

Symptoms, investigations and alternatives are reviewed during consultation to create a safe, individualised treatment plan.

REA MED practice & directions

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