A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

Abstract

Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury. Methods A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-o’clock position as cranial, 6-o’clock as dorsal, 9-o’clock as caudal, and 12-o’clock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images. Results All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-o’clock position, 6-o’clock position, 9-o’clock position, 12-o’clock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-o’clock and 12-o’clock position were pitfalls that might cause biliary injury. Conclusion The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.

Analysis of risk factors for bile duct injury in laparoscopic cholecystectomy in China: A systematic review and meta-analysis

“…In addition, the anatomic variations of the gallbladder triangle were recognized as a risk factor for LC-related bile duct injury. [ 19 , 20 ] Approximately 70% to 80% of iatrogenic bile duct injuries occur because of the incorrect identification of biliary tract anatomical structure, [ 21 ] and anatomic variations render it difficult to distinguish between the cystic duct, the common hepatic duct, and the common bile duct. Bile duct variations are diverse, with the parallel or spiral confluence of the cystic duct and the common hepatic duct being the most common cause of bile duct injury.…”

Kết quả phẫu thuật nội soi cắt túi mật do viêm túi mật cấp có sử dụng ống hút nội soi để phẫu tích: Hồi cứu 198 ca bệnh tại Bệnh viện Bạch Mai

“…14 Mặc dù, tỷ lệ tổn thương ống mật chính khoảng 0,58% -0,79% nhưng là "thảm họa" trong phẫu thuật nội soi. 11,15 Tổn thương đường mật có thể gây ra các biến chứng nặng như viêm phúc mạc, mổ lại để nối mật ruột và nguy cơ tử vong. 15,16 Vào năm 1995, Strasberg đưa ra khái niệm "Tiêu chuẩn an toàn -Critical View of Safety hay viết tắt là CVS" để giảm thiểu nguy cơ tổn thương đường mật trong phẫu thuật nội soi cắt túi mật.…”

The Laparoscopic Anatomy of Rouviere’s Sulcus

“…4 Therefore, precise identification of frequently variable biliary anatomy is a key factor in prevention of BDI during LC. 5 Critical view of safety (CVS) is an operative strategy to prevent BDI by using various anatomical landmarks during LC. 6 Rouviere's sulcus is a naturally occurring fissure on the visceral surface of the junction between right and caudate lobe.…”