Aims — to study the optimization approaches in gasless laparoscopic cholecystectomy.
Methods. We used gasless laparoscopic cholecystectomy in strict conditions, which include: elderly age of the patient, the presence of severe cardiopulmonary disease, heart defects. From 2011 to 2014 we have performed 18 such interventions. Postoperative complications occurred in 3 patients. There were no deaths.
Results. The distinctive features of the operative technique are the following: 1) The projective introduction of the upper 5 mm port directly below the costal margin and the seizure of the gallbladder by the port not in the bottom area, but closer to the cervix, that allows to create both the traction of the gallbladder and establish the largest working area under the liver; 2) Mobilization of the body and the neck of the gallbladder before the mobilization of the hepatoduodenal ligament, which allows to create greater mobility of vascular-ductal structures and improve visualization; 3) Prune the gallbladder from the bed — it is appropriate to preliminary separate the bottom area to prevent its detachment. The drainage was performed conventionally — by two 16–18 F pipe drains, to the bladder bed and the right side. Intraoperative blood loss was (130.0±37.5) ml, the operative time was 68.75 minutes. Conversions have not been applied.
Conclusion. The advantages of this technique are the expansion of the category of patients whom laparoscopic techniques can be applied to, better visualization comparing to open methods, and early patients’ activation.