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                                                   Prevention of Common Bile Duct Injuries in Laparoscopic Cholecystectomy

          use knowledge of psychologic factors in the production of  3. Deziel DJ, Millikan KW, Economou SG, et al. Complications
                                                                  of laparoscopic cholecystectomy: A national survey of 4,292
          error. This is the human factors approach described by
                                                                  hospitals and an analysis of 77,604 cases. Am J Surg 1993;165:
          Reason in ‘high-reliability organizations’, such as air-traffic
                                                                  9-14.
          control and the nuclear power industry. 31  In such  4. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG.
          environments, highly trained professionals carry out    Bile duct injury during laparoscopic cholecystectomy: Results
          complex technical tasks and are sometimes required to make  of a national survey. Ann Surg 2001;234:549-59.
                                                               5. Richardson MC, Bell G, Fullarton GM. Incidence and nature of
          rapid decisions in conditions of uncertainty with potentially
                                                                  bile duct injuries following laparoscopic cholecystectomy: An
          disastrous consequences of mistakes. Some error is      audit of 5,913 cases. West of Scotland Laparoscopic Chole-
          inevitable when human beings interact with complex      cystectomy Audit Group. Br J Surg 1996;83:1356-60.
          technical environments, as in the operating room. A specific  6. Hugh TB. New strategies to prevent laparoscopic bile duct
                                                                  injury—surgeons can learn from pilots. Surgery 2002;132(5):
          type of error, recognized as the cause of some aircraft
                                                                  826-35.
          crashes, seems to operate in many cases of bile duct injury:
                                                               7. Gossage JA, Forshaw MJ. Prevalence and outcome of litigation
          The false hypothesis or deadly mind-set error. A mistaken  claims in England after laparoscopic cholecystectomy.
          perception, that a particular duct is the cystic duct, provides  International Journal of Clinical Practice 2010;64(13);1832-35.
                                                               8. Davidoff AM, Pappas TN, Murray EA, et al. Mechanisms of
          the setting for this type of error in cholecystectomy. The
                                                                  major biliary injury during laparoscopic cholecystectomy. Ann
          surgeon may develop a functional fixity and reject evidence
                                                                  Surg 1992;215:196-202.
          of a mistake. The unwillingness of juniors to question the  9. Schol FP, Go PM, Gouma DJ. Risk factors for bile duct injury
          actions of seniors has been identified as a significant  in laparoscopic cholecystectomy: Analysis of 49 cases. Br J
          contribution to errors in the operating room. The       Surg 1994;81:1786-88.
                                                              10. Russell JC, Walsh SJ, Mattie AS, Lynch JT. Bile duct injuries
          characteristics of a surgeon at low risk for error is often
                                                                  1989-93: A statewide experience. Connecticut Laparoscopic
          identified as being a person who expects unpleasant     Cholecystectomy Registry. Arch Surg 1996;131:382-88.
          surprises; accepts input from others; is ready to modify  11. Ooi LLPJ, Goh YC, Chew SP, et al. Bile duct injuries during
          hypotheses; and recognizes the effects of self-fatigue, time  laparoscopic cholecystectomy: A collective experience of four
                                                                  teaching hospitals and results of repair. Aust NZJ Surg
          pressures, and personal worries on surgical performance.
                                                                  1999;69:844-46.
          Hunter suggested that a team approach may be beneficial,
                                                              12. Cates JA, Tompkins RK, Zinner MJ, Busuttil RW, Kallman C,
          stating that the cystic duct should not be clipped until all  Roslyn JJ. Biliary complications of laparoscopic cholecystec-
          members of the operating team are contented that the    tomy. Am Surg 1993;59:243-47.
          dissection is complete. 16                          13. Strasberg SM. Avoidance of biliary injury during laparoscopic
                                                                  cholecystectomy. J Hepatobiliary Pancreat Surg 2002;9:
                                                                  543-47.
          CONCLUSION
                                                              14. Strasberg SM, Eagon CJ, Drebin JA. The hidden cystic duct
                                                                  syndrome and the infundibular technique of laparoscopic
          Bile duct injuries have cast a shadow of apprehension on
                                                                  cholecystectomy—the danger of the false infundibulum. J Am
          an otherwise wonderful procedure of laparoscopic
                                                                  Coll Surg 2000;191:661-67.
          cholecystectomy. Millions have benefited from this advance  15. Francoeur JR, Wiseman K, Buczkowski AK, Chung SW,
          against gallbladder disease. Hence, to preserve these   Scudamore CH. Surgeons’ anonymous response after bile
          benefits, the operating surgeon has to be aware of the factors  duct injury during cholecystectomy. Am J Surg 2003;185:
                                                                  468-75.
          responsible for these injuries and take appropriate measures
                                                              16. Hunter JG. Avoidance of bile duct injury during laparoscopic
          to prevent them. This requires strict adherence to the  cholecystectomy. Am J Surg 1991;162:71-76.
          principles of meticulous dissection so that only positively  17. Troidl H. Disasters of endoscopic surgery and how to avoid
          identified structures are divided. Routine use of       them: Error analysis. World J Surg 1999;23:846-55.
                                                              18. Strasberg SM. Error traps and vasculobiliary injury in
          intraoperative cholangiograms and converting to open
                                                                  laparoscopic and open cholecystectomy. J Hepatobiliary
          procedure in the event of failure to progress or uncertain
                                                                  Pancreat Surg 2008;15:284-92.
          anatomy would go a long way in significantly reducing this  19. Strasberg SM. Rationale and use of the critical view of safety in
          mishap.                                                 laparoscopic cholecystectomy. J Am Coll Surg 2010;211(1):
                                                                  132-38.
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          World Journal of Laparoscopic Surgery, January-April 2012;5(1):27-32                              31
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