What is the frequency of BDIs? It's relatively rare — it's estimated
that only 0.4% of lap chole complications results in BDIs — but that
translates to about 3,000 nicked, burned or pinched bile ducts per
year when you consider that surgeons laparoscopically remove
750,000 to 1 million gallbladders annually. BDIs lead to symptoms that
can be painful, even deadly, if not treated. Here are tips to make a safe
operation safer.
One approach toward improving safety is standardizing dissection of
the gallbladder during surgery by creating a "critical view of safety" —
a technique endorsed by the Society of American Gastrointestinal and
Endoscopic Surgeons (SAGES). SAGES suggests these 6 strategies
that surgeons can employ to adopt a universal culture of safety for
cholecystectomies that minimizes the risk of BDIs.
1. Critical View of Safety. Use the Critical View of Safety
(CVS) method to identify the cystic duct and cystic artery during lap
choles. The 3 criteria required to achieve the CVS are:
• clear the hepatocystic triangle — the triangle formed by the cystic
duct, the common hepatic duct and the inferior edge of the liver — of
fat and fibrous tissue;
• separate the lower one-third of the gallbladder from the liver to
expose the cystic plate, also known as the liver bed of the gallbladder;
and
• see 2 and only 2 structures when entering the gallbladder.
2. Aberrant anatomy. Understand the potential for aberrant
anatomy in all cases. Aberrant anatomy may include a short cystic
duct, aberrant hepatic ducts or a right hepatic artery that crosses
anterior to the bile duct.
5 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 9