{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:31:44Z","timestamp":1772987504829,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":299,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Gallbladder bed detachment (GBB\u2010D) in laparoscopic cholecystectomy (LC) lacks a standardized technique. We developed butterfly traction (BT) to perform optimal GBB\u2010D. This study evaluates its effectiveness and potential for standardization.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n BT aligns the dissection axis with the surgeon's dominant hand by positioning the gallbladder upright and using a left\u2010sided lateral approach. This improves right\u2010side mobility, enabling horizontal traction and avoiding axis interference. BT has been adopted in all LCs at our institution since July 2023. Among 118 LCs performed from 2019 to 2024, three open conversion cases and 13 bailout cases were excluded. Operative outcomes in the remaining patients were compared between the BT group (\n n<\/jats:italic>\n \u2009=\u200950) and the nonstandardized (NS) group (\n n<\/jats:italic>\n \u2009=\u200952).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n No significant differences were observed in age, gender, comorbidities, or preoperative gallbladder drainage between groups. However, the BT group had more surgeons with \u2264\u20095\u2009years of experience (52% vs. 29%,\n p<\/jats:italic>\n \u2009=\u20090.017). Operative times were comparable (\n p<\/jats:italic>\n \u2009=\u20090.363), but bile contamination due to gallbladder perforation during GBB\u2010D was significantly lower in the BT group (4% vs. 17%,\n p<\/jats:italic>\n \u2009=\u20090.030), as was blood loss (0 vs. 1\u2009g,\n p<\/jats:italic>\n \u2009=\u20090.003). BT was particularly effective in higher difficulty cases (Grade B\/C from Tokyo Guidelines 2018), with shorter operative times (95 vs. 116\u2009min,\n p<\/jats:italic>\n \u2009=\u20090.095), less blood loss (0 vs. 2\u2009g,\n p<\/jats:italic>\n \u2009<\u20090.001), and fewer perforations (6% vs. 24%,\n p<\/jats:italic>\n \u2009=\u20090.046).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n BT improved surgical outcomes and minimized bile contamination, even when performed by less experienced surgeons. It shows strong potential as a standard technique for GBB\u2010D in LC.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ases.70171","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T04:30:02Z","timestamp":1761625802000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Butterfly Traction: A New Standardized Approach for Gallbladder Bed Detachment in Laparoscopic Cholecystectomy"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1980-9224","authenticated-orcid":false,"given":"Daisuke","family":"Noguchi","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7189-357X","authenticated-orcid":false,"given":"Aoi","family":"Hayasaki","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Iizawa","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehiro","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University Graduate School of Medicine Tsu 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