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An 18-year-old woman presented with a first episode of biliary colic. Ultrasound revealed cholelithiasis with normal gallbladder wall thickness, no pericholecystic fluid and normal size common duct. She had no history of jaundice or pancreatitis and no prior abdominal surgery. She was taken to the operating room for laparoscopic cholecystectomy. The umbilical camera port was placed using the Hasson technique. Insufflation of carbon dioxide was started at 2L per min. in order to not suddenly increase abdominal pressure through the large bore Hasson cannula and reduce venous return. Once the pressure had equilibrated at 13 mm Hg, the flow was turned up to 6L. The viscera were checked for trochar injury upon inserting the camera.
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A 10-mm epigastric port was placed on a line parallel with the position of the gallbladder. Higher placement may result in interference by the lateral segment of the left lobe of the liver. The trochar tip was engaged in the midline fascia and then directed to the right to emerge at the angle between abdominal wall and right side of the falciform ligament.
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