Laparoscopic Cholecystectomy and Increased Risk of Bile Duct Injury

Surgical Accidents & Pennsylvania Law

With the increasing popularity of laparoscopic cholecystectomy in the United States, an appropriate and even preferred alternative to open cholecystectomy, we find unintentional bile duct injuries associated with a laparoscopic procedure occurring at twice the rate of similar injuries with open procedures.

Some believe that as experience with the laparoscopic cholecystectomy increases that the incidence of common bile duct injuries associated with the technique will diminish. Others dispute this.

A laparoscopic cholecystectomy is performed without need of the large abdominal incision required to otherwise perform the procedure. The open procedure is not only a major abdominal operation but is associated with prolonged recovery, scarring and pain.

The laparoscopic cholecystectomy permits the removal of the gallbladder through a small hole placed in the abdominal wall. The performance of the procedure requires that several small holes be placed in the abdomen through which instruments are introduced so as to manipulate the gallbladder and control those devices needed to divide the gallbladder from the cystic duct and to separate it from its attachment to the liver.

The principle difference from the surgeon’s perspective between a laparoscopic procedure and an open procedure is the lack of a three-dimensional view of the structure to be manipulated. During a laparoscopic procedure a surgeon is guided by a two-dimensional image seen on a television screen. This has a very different look and feel to the view that is obtained when one opens the abdomen and exposes the gallbladder directly. Depth perception is affected. Operating instruments at a significant distance from the point of application requires a higher level of coordination that would be necessary for a surgeon operating during an open procedure.

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