Mirizzi SyndromeIn their recent article on cholecystectomy for the Mirizzi Syndrome, Tan et al ., recommended the open approach. 1 The accompanying commentary questioned whether this topic really warrants the number of publications that it generates. 2 I feel that most can be managed laparoscopically and would like to share the details of the operative technique that I have found useful for the Mirizzi Syndrome and difficult laparoscopic cholecystectomy.Using a laparoscopic retrograde approach, either fundus first or starting at the mid-portion of the gallbladder, the gallbladder is mobilized as much as possible. This is facilitated by the use of a laparoscopic liver retractor of the type used for hiatal surgery. Once freed from the liver, the gallbladder's attachment to the bile duct can better be assessed. The gallbladder is opened, the impacted stone removed and put into a previously placed retrieval bag. In some cases, a linear endoscopic stapler can then be used to accurately seal and divide the attachment of the gallbladder to the bile duct (Fig. 1).