Use of Critical View of Safety and Proctored Preceptorship in Preventing Bile Duct Injury During Laparoscopic Cholecystectomy—Experience of 3726 Cases From a Tertiary Care Teaching Institute

Abstract

Introduction: Bile duct injury (BDI) continues to occur despite technological advances and improvements in surgical training over the past 2 decades. This study was conducted to audit our data on laparoscopic cholecystectomies performed over the past 2 decades to determine the role of Critical View of Safety (CVS) and proctored preceptorship in preventing BDI and postoperative complications. Materials and Methods: All patients undergoing elective laparoscopic cholecystectomy were analyzed retrospectively. The data were obtained from a prospectively maintained database from January 2004 to December 2019. Proctored preceptorship was used in all cases. Intraoperative details included the number of patients where CVS was defined, number of BDI and conversions. Postoperative outcomes, including hospital stay, morbidity, and bile duct stricture, were noted. Results: Three thousand seven hundred twenty-six patients were included in the final analysis. Trainee surgeons performed 31.6% of surgeries and 9.5% of these surgeries were taken over by the senior surgeon. A CVS could be delineated in 96.6% of patients. The major BDI rate was only 0.05%. Conclusion: This study reiterates the fact that following the basic tenets of safe laparoscopic cholecystectomy, defining and confirming CVS, and following proctored preceptorship are critical in preventing major BDI.

Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study

“…In a study by Duca et al ( 3 ), GB perforation was 15.9%, while bleeding was 2.3%. In another study, the bleeding was 5.1% and they used drain in 26.5% of the cases ( 17 ), and others reported GB perforation in 4.9% of cases, bleeding in 0.4% and stone spillage in 2.5% ( 19 ). In a comprehensive study conducted by Nassar et al ( 27 ), the CR was reported at 0.49%.…”

“…According to a systematic review and meta-analysis in China, the incidence rate of BDI was 1.12% (16). In a large study in India (17), it was 0.05%, and in a local study (Sulaimani, Kurdistan region, Iraq) (18), it was 0.4%. However, a study by Buddingh et al (4) from the Netherlands showed a significantly lower rate of major BDI after the implementation of routine IOC (1.9 vs. 0%).…”

Laparoscopic cholecystectomy in Jos: Prospects and perspectives

“…[ 5 6 ] In the early years of its use, there was an unacceptable high incidence of bile duct injury which reduced with growing experience all over the world. [ 7 8 9 ]…”