Butterfly Traction: A New Standardized Approach for Gallbladder Bed Detachment in Laparoscopic Cholecystectomy.

INTRODUCTION

Gallbladder bed detachment (GBB-D) in laparoscopic cholecystectomy (LC) lacks a standardized technique. We developed butterfly traction (BT) to perform optimal GBB-D. This study evaluates its effectiveness and potential for standardization.

METHODS

BT aligns the dissection axis with the surgeon's dominant hand by positioning the gallbladder upright and using a left-sided lateral approach. This improves right-side mobility, enabling horizontal traction and avoiding axis interference. BT has been adopted in all LCs at our institution since July 2023. Among 118 LCs performed from 2019 to 2024, three open conversion cases and 13 bailout cases were excluded. Operative outcomes in the remaining patients were compared between the BT group (n = 50) and the nonstandardized (NS) group (n = 52).

RESULTS

No significant differences were observed in age, gender, comorbidities, or preoperative gallbladder drainage between groups. However, the BT group had more surgeons with ≤ 5 years of experience (52% vs. 29%, p = 0.017). Operative times were comparable (p = 0.363), but bile contamination due to gallbladder perforation during GBB-D was significantly lower in the BT group (4% vs. 17%, p = 0.030), as was blood loss (0 vs. 1 g, p = 0.003). BT was particularly effective in higher difficulty cases (Grade B/C from Tokyo Guidelines 2018), with shorter operative times (95 vs. 116 min, p = 0.095), less blood loss (0 vs. 2 g, p < 0.001), and fewer perforations (6% vs. 24%, p = 0.046).

CONCLUSIONS

BT improved surgical outcomes and minimized bile contamination, even when performed by less experienced surgeons. It shows strong potential as a standard technique for GBB-D in LC.