CALOT: safe laparoscopic cholecystectomy, from the anatomy to the bail-out
Cholecystectomy Anatomy, Learning & Operative TechniqueTeaching site for surgeons · Evidence-linked · Exam practice
Safe laparoscopic cholecystectomy, from the anatomy to the bail-out.
A practical guide for surgical residents and consultants, with key points, worked cases and linked evidence.
Designed and developed by Dr Prasad Bhukebag
Choose your route
- 21 teaching topics
- 10 worked cases
- Each page shows its review date
- Key claims labelled by type of source
All topics
- 01Anatomy and variantsLandmarks, duct and artery variants, and the anatomy behind bile duct injury.
- 02Indications and workupPatient selection, investigations, duct stones and antibiotic prophylaxis.
- 03Timing in acute cholecystitisAcute cholecystitis grading, timing of surgery and gallbladder drainage.
- 04Imaging for surgeonsUltrasound, CT, MRCP, endoscopic ultrasound and HIDA in context.
- 05Cholangitis and pancreatitisDiagnosis, severity, drainage, ERCP and timing after pancreatitis.
- 06Operative techniquePositioning, ports, retraction, dissection, clipping and closure.
- 07Critical View of SafetyThe three criteria, the doublet view and common false impressions.
- 08Predicting difficultyPre-operative predictors and operative grading systems.
- 09ICG fluorescenceDose, timing, interpretation, limitations and comparison with cholangiography.
- 10Bail-out strategiesThe stop rule, subtotal cholecystectomy and choosing a safe exit.
- 11Open and conversionWhen conversion helps, open technique and postoperative care.
- 12Bile duct explorationDuct clearance, transcystic exploration, choledochotomy and closure.
- 13Robotic and single-incisionRobotic outcomes, single-incision surgery and adopting a platform safely.
- 17Culture of safetyTime-outs, teamwork, cognitive bias, documentation and debriefing.
- 18Consent and communicationDiscussing risk, complications, conversion and unexpected outcomes.
- 19Day-case pathwaysSelection, analgesia, discharge criteria and follow-up.
- 20Medicolegal issuesConsent, documentation, candour and the Indian clinical context.
- 21Training and assessmentSupervision, assessment, simulation and maintaining operative skills.
How to use this site
- Read in order if you are preparing for an exam. The pages build on each other: anatomy, then indications and timing, then the operation and the ways to make it safe, then complications and special situations, then safety culture and communication. Each page opens with three things to remember. Open the “More detail and sources” panels when you want the evidence behind a point.
- Jump straight to a page if you have a question before a list or a clinic. The quick reference has the safety checklist and two decision pathways.
- Test yourself in the Exam zone when you have read a page or before an exam. Every question is tagged by exam, topic and difficulty, every answer is explained with a link back to the page, and the mock papers follow the format of each exam. Your answers and bookmarks stay in this browser.
- Use the search box at the top to find any term, landmark, trial name or guideline across every page.
How evidence is marked
Every page cites its sources inline, with links, and gives the date of the most recent source used. Claims are labelled by the type of source they rest on, so that you can see at a glance what kind of evidence sits behind them. These are source types, not grades: a guideline can rest on very low certainty evidence, and the pages say so where that is the case. Where a point is uncertain, the uncertainty is written beside the recommendation itself, not only inside the sources panel:
- Guideline A recommendation from a published guideline or consensus statement (SAGES, the multi-society consensus, SAGES–AHPBA, Tokyo Guidelines 2018, WSES, NICE, IDSA). The strength and certainty are given beside it where the guideline states them.
- Systematic review A systematic review or meta-analysis. These pool studies; they are only as good as the studies pooled.
- Randomised trial A randomised controlled trial, named on the page.
- Observational Cohorts, registries, case series and other non-randomised data, including observational meta-analyses.
- Expert opinion Widely taught practice supported by expert consensus or the author’s own practice, not by trials.
- Contested A point on which the literature disagrees or the evidence is weak, recent or changing. The page says what the disagreement is.
- Changed recently Guidance that has changed in the last few years, where older textbooks and some examiners may still teach the previous position.
Sources are from 2018 onward wherever possible, with priority given to the last three years, and older landmark papers are included where they are still the basis of practice. Each page shows the date it was last reviewed against its sources, and lists any figure or wording that could not be checked against the primary source. Where a figure is a drawing it is labelled as a schematic. Photographs and figures reproduced from open-access papers carry their source and licence.
What this site is and is not
It is a teaching resource for training and exam revision. It is not a clinical protocol: your unit’s pathways, your patient and your own judgement take precedence. Numbers quoted are from the cited sources and are rounded for teaching; follow the links for the originals. Abbreviations are defined on each page the first time they appear.