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Thumbs Up on Safety Scalpels - Outpatient Surgery Magazine - May 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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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

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