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Retrograde tracing along “cystic duct” method to prevent biliary misidentification injury in laparoscopic cholecystectomy

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Abstract

Bile duct injury remains the most serious complication of laparoscopic cholecystectomy (LC), the main cause was misidentification of cystic duct (CD). The aim of this study was to evaluate the effectiveness and security of retrograde tracing along “cystic duct” (RTACD) method for the prevention of biliary misidentification injury in LC. The conception of RTACD method was first described and then illustrated by simulation dissection with extrahepatic biliary structure charts. A total of 840 patients undergoing LC were selected. After the “CD” was separated during operation, its authenticity was identified by RTACD method according to its course and origin. The “CD” can be clipped/divided only when it was identified to be true CD. Among 840 patients, the initially separated “CD” was identified as actual CD in 831 cases, common hepatic (bile) duct in six cases, accessory right posterior sectoral duct in two cases, and right haptic duct in one case. LCs were successfully finished in 837 patients, and converted to open cholecystectomy in three cases. The average operation time was 64.23 min (range 25–225 min), and the average blood loss was 8.07 ml (range 2–200 ml). No biliary misidentification injury was found. All patients recovered smoothly. No jaundice or abdominal pain was noted in the patients during 1–19 months follow-up. RTACD method is a safe and effective new technique of preventing biliary misidentification injury.

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References

  1. Go PM, Schol F, Gouma DJ (1993) Laparoscopic cholecystectomy in the Netherlands. Br J Surg 80(9):1180–1183

    Article  CAS  PubMed  Google Scholar 

  2. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125

    CAS  PubMed  Google Scholar 

  3. Archer SB, Brown DW, Smith D et al (2001) Bile duct injury during laparoscopic cholecystectomy. Results of a national survey. Ann Surg 234(4):549–558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Way LW, Stewart L, Wet G et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237(4):460–469. https://doi.org/10.1097/01.SLA.0000060680.92690.E9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Strasberg SM (2005) Biliary injury in laparoscopic surgery: part 1. Processes used in determination of standard of care in misidentification injuries. J Am Coll Surg 201(4):598–603

    Article  PubMed  Google Scholar 

  6. Strasberg SM, Brunt LM (2010) Rationale and use of the critical view of safety in laparo-scopic cholecystectomy. J Am Coll Surg 211(1):132–138. https://doi.org/10.1016/j.jamcollsurg.2010.02.053

    Article  PubMed  Google Scholar 

  7. Hori T, Oike F, Furuyama H, Machimoto T et al (2016) Protocol for laparoscopic cholecystectomy: is it rocket science? World J Gastroenterol 22(47):10287–10303. https://doi.org/10.3748/wjg.v22.i47.10287

    Article  PubMed  PubMed Central  Google Scholar 

  8. Strasberg SM, Eagon CJ, Drebin JA (2000) The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy—the danger of the false infundibulum. J Am Coll Surg 191(6):661–667

    Article  CAS  PubMed  Google Scholar 

  9. Strasberg SM (2002) Avoidance of biliary injury during laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 9(5):543–547. https://doi.org/10.1007/s005340200071

    Article  PubMed  Google Scholar 

  10. Dekker SW, Hugh TB (2008) Laparoscopic bile duct injury: understanding the psychology and heuristics of the error. ANZ J Surg 78:1109–1114. https://doi.org/10.1111/j.1445-2197.2008.04761.x

    Article  PubMed  Google Scholar 

  11. Callery MP (2006) Avoiding biliary injury during laparoscopic cholecystectomy: technical considerations. Surg Endosc 20(11):1654–1658. https://doi.org/10.1007/s00464-006-0488-3

    Article  CAS  PubMed  Google Scholar 

  12. Nijssen MA, Schreinemakers JM, van der Schelling GP et al (2016) Improving critical view of safety in laparoscopic cholecystectomy by teaching Interventions. J Surg Educ 73(3):442–447. https://doi.org/10.1016/j.jsurg.2015.11.015

    Article  PubMed  Google Scholar 

  13. Alvarez FA, de Santibañes M, Palavecino M et al (2014) Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg 101(6):677–684. https://doi.org/10.1002/bjs.9486

    Article  CAS  PubMed  Google Scholar 

  14. Törnqvist B, Strömberg C, Akre O et al (2015) Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy. Br J Surg 102(8):952–958. https://doi.org/10.1002/bjs.9832

    Article  PubMed  Google Scholar 

  15. Wakabayashi G, Iwashita Y, Hibi T et al (2018) Tokyo guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25(1):73–86. https://doi.org/10.1002/jhbp.517

    Article  PubMed  Google Scholar 

  16. Conrad C, Wakabayashi G, Asbun HJ et al (2017) IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 24(11):603–615. https://doi.org/10.1002/jhbp.491

    Article  PubMed  Google Scholar 

  17. Hunter JG (1991) Avoidance of bile duct injury during laparoscopic cholecystectomy. Am J Surg 162(1):71–76

    Article  CAS  PubMed  Google Scholar 

  18. Cai XJ, Ying HN, Yu H et al (2015) Blunt dissection: a solution to prevent bile duct injury in laparoscopic cholecystectomy. Chin Med J (Engl) 128(23):3153–3157. https://doi.org/10.4103/0366-6999.170270

    Article  Google Scholar 

  19. Avgerinos C, Kelgiorgi D, Touloumis Z et al (2009) One thousand laparoscopic cholecystectomies in a single surgical unit using the “critical view of safety” technique. J Gastrointest Surg 13(3):498–503. https://doi.org/10.1007/s11605-008-0748-8

    Article  CAS  PubMed  Google Scholar 

  20. Honda G, Hasegawa H, Umezawa A (2016) Universal safe procedure of laparoscopic cholecystectomy standardized by exposing the inner layer of the subserosal layer (with video). J Hepatobiliary Pancreat Sci 23(9):E14–19. https://doi.org/10.1002/jhbp.382

    Article  PubMed  Google Scholar 

  21. Gupta V, Jain G (2019) Safe laparoscopic cholecystectomy: adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg 11(2):62–84. https://doi.org/10.4240/wjgs.v11.i2.62

    Article  PubMed  PubMed Central  Google Scholar 

  22. Strasberg SM (2005) Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J Am Coll Surg 201(4):604–611. https://doi.org/10.1016/j.jamcollsurg.2005.04.032

    Article  PubMed  Google Scholar 

  23. Strasberg SM (2017) A perspective on the critical view of safety in laparoscopic cholecystectomy. Ann Laparosc Endosc Surg 2:91–94. https://doi.org/10.1002/jhbp.616

    Article  Google Scholar 

  24. Yegiyants S, Collins JC (2008) Operative strategy can reduce the incidence of major bile duct injury in laparoscopic cholecystectomy. Am Surg 74(10):985–987

    PubMed  Google Scholar 

  25. Dziodzio T, Weiss S, Sucher R et al (2014) A ‘critical view’ on a classical pitfall in laparoscopic cholecystectomy. Int J Surg Case Rep 5(12):1218–1221. https://doi.org/10.1016/j.ijscr.2014.11.018

    Article  PubMed  PubMed Central  Google Scholar 

  26. Strasberg SM (2008) Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg 15(3):284–292. https://doi.org/10.1007/s00534-007-1267-9

    Article  PubMed  Google Scholar 

  27. Giger U, Ouaissi M, Schmitz SF et al (2011) Bile duct injury and use of cholangiography during laparoscopic cholecystectomy. Br J Surg 98(3):391–396. https://doi.org/10.1002/bjs.7335

    Article  CAS  PubMed  Google Scholar 

  28. Carroll BJ, Friedman RL, Liberman MA et al (1996) Routine cholangiography reduces sequelae of common bile duct injuries. Surg Endosc 10(12):1194–1197

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are grateful to all surgeons, First Department of Hepatobiliary Surgery, Yijishan Hospital of Wannan Medical College, for their contribution to operation and data collection. We thank Dr. G. Feng, Department of Clinical Laboratory, Yijishan Hospital of Wannan Medical College, for critically revising the manuscript.

Funding

This study was supported by the Key Research and Development Program of Anhui Province, China (No. 1804h08020273).

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Authors and Affiliations

  1. First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China

    Xiaopeng Chen, Dong Wang, Wenjun Zhang, Dafei Dai, Weidong Zhang & Beibei Yu

  2. Department of Hepatobiliary Surgery, Huangshan People’s Hospital, Huangshan, China

    Bin Cheng

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  1. Xiaopeng Chen
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  2. Bin Cheng
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  3. Dong Wang
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Correspondence to Xiaopeng Chen.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Chen, X., Cheng, B., Wang, D. et al. Retrograde tracing along “cystic duct” method to prevent biliary misidentification injury in laparoscopic cholecystectomy. Updates Surg 72, 137–143 (2020). https://doi.org/10.1007/s13304-020-00716-7

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  • DOI: https://doi.org/10.1007/s13304-020-00716-7

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