Avoidance of bile duct injury during laparoscopic cholecystectomy

Research output: Contribution to journalArticle

204 Citations (Scopus)

Abstract

Common bile duct (CBD) injury during laparoscopic cholecystectomy appears to have a higher incidence than during open cholecystectomy. This may be a function of inadequate instruction, inadequate caution, or inexperience, or may represent an inherent flaw in laparoscopic exposure. The aim of this study was to identify several steps in laparoscopic exposure of the gallbladder, cystic duct, and Calot's triangle to minimize the risk of surgical disorientation and CBD injury. A review of the first 180 laparoscopic cholecystectomies from the author's series was performed. Maneuvers that provided optimal exposure of the critical anatomy were culled from the video record. These maneuvers were (1) routine use of a 30 ° forward oblique viewing telescope, (2) firm cephalic traction on the fundus of the gallbladder to reduce redundancy in the infundibulum of the gallbladder and best expose the cystic duct, (3) lateral traction on the infundibulum of the gallbladder to place the cystic duct perpendicular to the CBD, (4) dissection of the cystic duct at the infundibulum of the gallbladder, and (5) routine fluoroscopic cholangiography. If these steps do not provide the surgeon with comfortable anatomic orientation, the procedure should be converted to open cholecystectomy.

Original languageEnglish (US)
Pages (from-to)71-76
Number of pages6
JournalThe American Journal of Surgery
Volume162
Issue number1
DOIs
StatePublished - 1991
Externally publishedYes

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Laparoscopic Cholecystectomy
Cystic Duct
Bile Ducts
Gallbladder
Common Bile Duct
Pituitary Gland
Wounds and Injuries
Traction
Cholecystectomy
Telescopes
Cholangiography
Dissection
Anatomy
Head
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Avoidance of bile duct injury during laparoscopic cholecystectomy. / Hunter, John.

In: The American Journal of Surgery, Vol. 162, No. 1, 1991, p. 71-76.

Research output: Contribution to journalArticle

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