Table 1 Surgical difficulty grading system for laparoscopic cholecystectomy

0

1

2

3

4

5

6

Fibrosis /scarring of the gallbladder

Around the gallbladder

No findings

Fibrotic adhesion or partial scarring

Diffuse scarring

Calot’s triangle area

No findings

Sparse fibrosis

Dense fibrosis

Partial scarring

Diffuse scarring

Gallbladder bed

No findings

Sparse fibrosis

Dense fibrosis

Partial scarring

Diffuse scarring

Additional findings of the gallbladder

and its surroundings

No findings

Edematous change

Easy bleeding

Necrotic changes

Cholecystoenteric fistula

Cholecystocholedochal fistula (Mirizzi syndrome)

Perforated gallbladder wall and/or abscess formation

Abscess formation toward 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