Table 1.

Intraoperative difficulty scale for laparoscopic cholecystectomy [10]

Grade 1

Gallbladder—floppy, non-adherent

Cystic pedicle—thin and clear

Adhesions—simple up to the neck/Hartmann´s pouch

Grade 2

Gallbladder—mucocele, packed with stones

Cystic pedicle—fat laden

Adhesions—simple up to the body

Grade 3

Gallbladder—deep fossa, acute cholecystitis, contracted, fibrosis, Hartmann’s adherent to common bile duct, impaction

Cystic pedicle—abnormal anatomy or cystic duct—short, dilated or obscured

Adhesions—dense up to fundus; involving hepatic flexure or duodenum

Grade 4

Gallbladder—completely obscured, empyema, gangrene, mass

Cystic pedicle—impossible to clarify

Adhesions—dense, fibrosis, wrapping the gallbladder, duodenum or hepatic flexure difficult to separate

Easy: 1–2, difficult: 3–4