ABSTRACT
Cholecystectomy is one of the commonest elective surgical procedures performed today, with over 500 000 operations being performed annually in the United States alone.1 In the UK, the cholecystectomy rate is approximately 70 per 100 000 population per year.2 Evidence is accumulating that the cholecystectomy rate has risen markedly following the introduction of laparoscopic cholecystectomy. This unexplained increase in rate may reflect surgical enthusiasm for a new procedure with consequent alteration of operative indications, rather than a true increase in the incidence of symptomatic gallbladder stones.3,4
Standard (‘open’) cholecystectomy
The first successful cholecystectomy in a human was performed by Karl Langenbuch in 1882 who used a T-shaped incision in the right upper quadrant of the abdomen. Theodor Kocher (1841-1917) is generally credited with the long right subcostal incision which has been used as a ‘standard’ approach to cholecystectomy for most of the previous century.5 Cholecystectomy through any upper abdominal incision has been the accepted treatment for symptomatic gallstones for over a century.6
