Citations 11
Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul‐de‐sac or the birth pangs of a new technical framework?
Iwashita, Yukio , Hibi, Taizo , Ohyama, Tetsuji , Umezawa, Akiko , Takada, Tadahiro , Strasberg, Steven M. , Asbun, Horacio J. , Pitt, Henry A. , Hwang, Tsann‐Long , Choi, In‐Seok , Yoon, Dong Sup , Huang, Wayne Shih‐Wei, Yoshida, Masahiro , Wakabayashi, Go , Miura, Fumihiko, Okamoto, Kohji , Endo, Itaru , Santibáñes, Eduardo de , Giménez, Mariano , Windsor, John A. , Garden, O. James , Gouma, Dirk J., Cherqui, Daniel , Belli, Giulio, Dervenis, Christos, Deziel, Daniel J., Jonas, Eduard , Jagannath, P., Supe, Avinash , Singh, Harjit , Liau, Kui‐Hin, Chan, Angus C. W., Lau, Wan Yee , Fan, Sheung Tat , Chen, Miin‐Fu , Kim, Myung‐Hwan , Sugioka, Atsushi , Asai, Koji , Wada, Keita, Mori, Yasuhisa , Higuchi, Ryota , Misawa, Takeyuki , Matsumura, Naoki , Rikiyama, Toshiki, Kano, Nobuyasu, Tokumura, Hiromi, Kimura, Taizo, Kitano, Seigo, Inomata, Masafumi , Sumiyama, Yoshinobu, Inui, Kazuo, Yamamoto, Masakazu , Han, Ho-Seong , Suzuki, Kenji S. , Yoon, Yoo-Seok , Chen, Xiao‐Ping , Honda, Goro , Watanabe, Manabu , Sata, Naohiro , Hirata, Koichi , Jonas, Eduard
Journal of Hepato-Biliary-Pancreatic Sciences | September 8, 2017 | Volume: 24 | Issue: 11 | Pages: 591-602
Abstract Bile duct injury ( BDI ) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons’ perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. ( n = 614) participated in a questionnaire regarding their BDI experience and near‐misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five‐point scale. The consensus was built when ≥80% of overall responses were 4 or 5. Response rates for the first‐ and second‐round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI . Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/scarring in Calot's triangle, bail‐out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI .