Table 2 Surgical difficulty grading system for laparoscopic cholecystectomy
Surgical Difficulty Score | ||||||||
|---|---|---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | 4 | 5 | 6 | ||
Fibrosis/scarring of GBa | ||||||||
Around the GB | No findings | Fibrotic adhesion or partial scarring | Diffuse scarring | |||||
Calot’s triangle area | No findings | Sparse fibrosis | Dense fibrosis | Partial scarring | Diffuse scarring | |||
GB bed | No findings | Sparse fibrosis | Dense fibrosis | Partial scarring | Diffuse scarring | |||
Additional findings of the GB and its surroundings | No findings | Edematous change | Easy bleeding | Necrotic changes | Cholecystoenteric fistula | Cholecystocholedochal fistula (Mirizzi syndrome) | ||
Perforated GB wall and/or abscess formation | Abscess formation towards the liver parenchyma | Impacted gallstone in the confluence (Mirizzi syndrome) | ||||||
Intra-abdominal factors unrelated to inflammation | No findings | Non-inflammatory adhesion | Excessive visceral fat | GB neck mounting on the common bile duct | Inversion of the GB or collateral vein formation due to liver cirrhosis | |||
Anomalous bile duct | ||||||||