“Clipless” Cholecystectomy: Evolution Marches On, Even for Lap Chole

Excerpt

It is nearly a quarter century since laparoscopic cholecystectomy was introduced to surgeons and forever changed how we think about surgery. Laparoscopy changed not only how we accessed the gallbladder but almost every single element of how the surgery had been done for over 100 years, i.e., how the gallbladder was exposed and retracted, how Calot’s triangle was visualized, performing retrograde dissection versus antegrade, and the need for and frequency of cholangiography. One thing that did not change, however, was the method of ligating the cystic duct and artery. At least in the developed world, by the mid-1980s titanium clips had largely replaced suture ligation, which more often than not was performed only to demonstrate to residents and medical students how things were once done or to test their knot-tying abilities [1]. In fact, it was exclusively the development of the laparoscopic clip applier that made possible the widespread and rapid adoption of the procedure, as the ability to intracorporeally ligate the duct and artery was unthinkable to all but a handful of the most accomplished masters of laparoscopy of that time. …