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1) Perissat J, Collet DR, Belliard R : Gallstones ; laparoscopic treatment, intracorporeal lithotripsy followed by cholecystotomy on cholecystectomy. Endoscopy 21 : 373-374, 1989 2) Kato K, Matsuda M, Onodera K, et al : An ultrasonically powered instrument for laparoscopic surgery. J Laparosc Surg 5 : 31-36, 1995 5) Kato K, Matsuda M, Onodera K, et al : Laparoscopic cholecystectomy from fundus downward. Surg Laparosc Endosc 4 : 373-374, 1994 16) Longmire WP, Tompkins RK : Lesions of the segmental and lobar hepatic ducts. Ann Surg 182 : 478-495, 1975 17) Hermann RE : A plea for a safer technique of cholecystectomy. Surgery 79 : 609-611, 1976 52: 859-864, 1991 8) Zucker KA, Bailey RW, Gadacz TR, et al : Laparoscopic guided cholecystectomy. Am J Surg 161 : 36-44, 1991 11) Reddic EJ, Olsen DO : Laparoscopic laser cholecystectomy : A comparison with minilapa cholecystectomy. Surg Endosc 3 : 131-133, 1989

Experience with laparoscopic cholecystectomy for management of chronic cholecystitis with severe adhesion -Report of a case- Masato IMAI, Kazuya KATO, Shuichi KINO, Kazunori KAMIYA, Minoru MATSUDA, Shinichi KASAI, Micho MITO In this paper, experience with laparoscopic cholecystectomy successfully carried out in a patients with chronic cholecystitis with severe adhesion was reported. The patient was a 65-year-old man presented with a severe epigastralgia. Pre-operative examinations (ultrasonography, abdominal CT) revealed a severe cholecystitis with thicked wall and gallstones. Moreover it was suggested an existence of dense adhesion around to the gallbladder. After dissection of the omentum adhesed to the gallbladder, laparoscopic cholecystectomy from fundus downward (LCFD) was indicated in this particular case because a dense adhesion between the gallbladder neck and duodenum was noted. For performance of cholecystectomy, the use of ultrasonically powered aspirator was extremely effective to dissect the gallbladder from the gallbladder fossa. Moreover endoscopic linear cutter was useful in the cases whose gallbladder had to be dissected at its neck because the cystic duct was not clearly identified. Finally the use of LCFD technique was strongly advocated in the cases with severe cholecystitis to prevent bile duct injury. * Second Department of Surgery, Asahikawa Medical College (Asahikawa)