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[Position of the operative team during laparotomy cholecystectomy. Looking for the optimal perspective].

BACKGROUND
Surgeon's position during open cholecystectomy operation has been standardized since more than 100 years, being traditionally fixed at the right side of the patient. Only a few French authors adopted the "left location" just for the time requested for the common bile duct exploration.


METHODS
In this paper a critical evaluation of the optimal visual angle of the Calot's triangle elements is carried out. Laparoscopic experience has taught to those who practice it to forcefully adopt the "left position" thus approaching the anatomic structures from an internal-external point of view (opposite to the usual one). The authors have compared, on the basis of videotaped material, the "right" approach (adopted in conventional open surgery) and the "left" approach (coming from the laparoscopic experience).


RESULTS
From the comparative evaluation performed, a conclusion comes out that the left position allows a more accurate observation of the triangle of Calot and a more precise estimate of the "safe limit" from the hepatic artery and the common bile duct. Moreover it is observed that from this point of view the gallbladder infundibulum does not obstruct the vision of the hylus which is best evaluated in his third dimension thus attributing to each structure the right plane.


CONCLUSIONS
In conclusion from the data obtained in this paper the authors suggest to adopt the "left position" to approach the gallbladder surgery, particularly in the hylar dissecting phase.