Laparoscopic ‘D2 first’ approach for obscure gallbladders

Laparoscopic cholecystectomy has a reported incidence of 4%-15% of conversion to an open procedure and one of the main reasons behind the conversion is a gallbladder (GB) wrapped with dense adhesions. It is prudent to convert the procedure to an open operation in patients with particularly dense adhesions when the GB is not visible, preventing safe dissection which carries a potential risk of duodenal or colonic injury. The technique described, namely laparoscopic 'D2 first' approach, enables the completion of laparoscopic procedure in patients with 'obscure' GBs.