Gallbladder Removal With Dome Down Technique

If you're facing the possibility of surgery to remove your gallbladder, known in medical circles as a cholecystectomy, you'll no doubt be happy to know that laparoscopic surgical techniques have made recovery from this surgery far less challenging than it used to be. And a further refinement to laparoscopic cholecystectomy -- the dome down technique -- has helped reduce collateral damage to the bile duct that earlier laparoscopic procedures often caused.

Why You Need the Surgery

• If your doctor has recommended a cholecystectomy, you probably are suffering from gallbladder disease, also known as cholecystitis, or gallstones, known as cholelithiasis, according to the University of Illinois Medical Center. These are common ailments, which makes gallbladder removal one of the most widely performed surgical procedures in the United States.

Dome Down Technique

• What distinguishes the dome down approach from other forms of laparoscopic cholecystectomy? Although all laparoscopic procedures are minimally invasive forms of surgery, the dome down approach reverses the steps for removal of the inflamed gallbladder, beginning the dissection at the dome, or fundus, according to a paper by surgeons J. Stephen Scott and Roger A. de la Torre. Earlier laparoscopic techniques began dissection at the base of the gallbladder, near the triangle of Calot, a departure from the traditional approach used in open surgery, which began dissection at the dome. One of the unfortunate side effects of earlier laparoscopic techniques, according to Scott and de la Torre, was "an increased incidence of damage to biliary anatomy," seen most often as damage to the bile duct.

Scandinavian Study

• If you're wondering how well the procedure works, a Scandinavian study offers some valuable insights. The study, conducted by surgeons Jacob Rosenberg and T. Leinskold and published in a 2004 issue of the Scandinavian Journal of Surgery, examined the effectiveness of the dome down technique in combination with laparosonic (using sound waves) dissection of the gallbladder. The study group consisted of 20 patients, all of whom underwent the dome down procedure. The median age of patients in the study group was 50, and the median length of their surgical procedures was 35 minutes (ranging from a low of 20 to a high of 60 minutes).

  Rosenberg and Leinskold report that all patients "had uneventful clinical courses with no complications." Most patients were released from the hospital later on the day of their procedures, although one was held overnight to facilitate drainage from the site of the surgery. The surgeons point out that although the laparosonic dissection technique is nothing new, it seems to be an ideal choice "in cases of acute inflammation and in fibrosis or contraction of [the] triangle of Calot."