New strategies to prevent laparoscopic bile duct injury—surgeons can learn from pilots

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

“…Other strategies designed to reduce bile duct injuries, including the use of the anatomical landmark Rouvière's sulcus or a cholecystectomy checklist, have not been rigorously tested. 26,27 This study has some limitations. The primary aim of the CholeS study was to assess the variation in practice of cholecystectomy in the UK and was not designed to develop a risk score to predict conversion.…”

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

“…Traditionally, surgeons opt for operations with lower complication rates, and the ''learning curve'' was one of the arguments to account for the increased incidence of BDIs during LC [12]. However, further publications have reported that this incidence remains higher even when ''learning curve'' is accounted for [4,13,14], even in light of technological advances that have improved visualization and instrumentation [14][15][16][17][18]. Despite this evidence, LC remains the treatment of choice for symptomatic gallstones, a fact most likely attributable to the benefits of less postoperative pain, shorter hospital stay, better cosmetic result, and increased patient satisfaction [12,[19][20][21][22].…”

Prevention of Common Bile Duct Injuries in Laparoscopic Cholecystectomy

“…It has been suggested that the commonest cause of common bile duct injury is misidentification of biliary anatomy (70-80%). 6 There are two main types of misidentification. In the first scenario, the common duct is mistaken for the cystic duct, and is occluded and divided.…”

“…Furthermore, it continues to be two to three times more common compared with published major bile duct injury rates for open cholecystectomy which indicates that this is still an incompletely resolved problem. 5,6 The problem is especially highlighted as patients sustaining a bile duct injury (BDI) during cholecystectomy have an impaired quality of life. Bile duct injuries often necessitate several invasive procedures and subsequent operations causing fear and anxiety to patients as well as surgeons.…”