Table 2. Intraoperative grading system for difficult laparoscopic cholecystectomy.

BMI: body mass index

Gallbladder appearance
No adhesions	0
Adhesions	1
Adhesions < 50% and completely buried Gallbladder	2
Gallbladder is completely buried in adhesion	3
Distension/Contraction
Distended Gallbladder (or contracted shriveled G Gallbladder)	1
Unable to grasp with atraumatic laparoscopic forceps	1
Stone ≥1 cm impacted in Hartman’s Pouch	1
Access
BMI >30	1
Adhesions from previous surgery limiting access	1
Severe Sepsis/Complications
Bile or Pus outside Gallbladder	1
Time to identify cystic artery and duct >90 minutes	1
Degree of difficulty
Mild	<2
Moderate	2-4
Severe	5-7
Extreme	8-10