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      Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy.

      World journal of gastrointestinal surgery
      Baishideng Publishing Group Inc
      Bile duct injury, Cholelithiasis, Cholecystitis, Cholecystectomy, Bile leak

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          Abstract

          The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.

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          Most cited references71

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          An analysis of the problem of biliary injury during laparoscopic cholecystectomy.

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            The Brisbane 2000 Terminology of Liver Anatomy and Resections

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              Rationale and use of the critical view of safety in laparoscopic cholecystectomy.

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                Author and article information

                Journal
                30842813
                6397793
                10.4240/wjgs.v11.i2.62

                Bile duct injury,Cholelithiasis,Cholecystitis,Cholecystectomy,Bile leak

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