Surgical Accidents
Laparoscopic Cholecystectomy and Increased Risk of Bile Duct Injury (continued)

Notwithstanding the limitations of a laparoscopic cholecystectomy from the surgeon’s perspective, there are certain profound advantages to the patient. The quantity of tissue needlessly damaged simply to secure a view of gallbladder is completely eliminated. Though the view by television is two dimensional, the view is dry and clear. The abdominal wall is raised by inflation of air into the abdomen so that it appears to the laparoscopist as a dome. It is like watching some surgical contest being performed in an empty arena and at its center a generally green lustrous gallbladder as a target.

One wonders then how bile duct injuries occur so frequently when the laparoscopic procedure is employed. There is a specific technique that must be utilized during a laparoscopic procedure in order to assure the surgeon the best opportunity to identify the cystic duct (that duct connecting the gallbladder to the common bile duct) and the juncture of the cystic duct and the common bile duct. The area where the ducts connect is covered with gauze-like tissue and if this tissue is not dissected in order that the actual connection between the cystic duct and the common bile duct can be seen, serious mistakes are made. The chance of error is greatly magnified by the fact that the cystic duct normally varies greatly in length. It can be very short. It can be very long. The surgeon can look at one part of the cystic duct and then think they are looking at part of the common bile duct.

In general, when appropriate surgical safeguards are employed in the performance of a laparoscopic cholecystectomy there is no unintended injury to the bile ducts. Unintended injury to the bile ducts when it occurs is often a result of doctors having failed to employ those safeguards deemed appropriate for the performance of such a procedure.

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