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A ‘critical view’ on a classical pitfall in laparoscopic cholecystectomy!.pdf
CASE REPORT – OPEN ACCESS
International Journal of Surgery Case Reports 5 (2014) 1218–1221
Contents lists available at ScienceDirect
International Journal of Surgery Case Reports
journal homepage:
A ‘critical view’ on a classical pitfall in laparoscopic cholecystectomy!
Tomasz Dziodzio a,?, Sascha Weiss b, Robert Sucher a, Johann Pratschke a, Matthias Biebl a
a Department of General, Visceral and Transplant Surgery, Charité, Berlin, Germany b Department of Visceral-, Transplant-, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
article info
Article history: Received 4 November 2014 Accepted 7 November 2014 Available online 12 November 2014
Keywords: Laparoscopic cholecystectomy Bile duct injury Critical view of safety Misperception
abstract
INTRODUCTION: Laparoscopic cholecystectomy is the most common laparoscopic surgery performed by general surgeons. Although being a routine procedure, classical pitfalls shall be regarded, as misperception of intraoperative anatomy is one of the leading causes of bile duct injuries. The “critical view of safety” in laparoscopic cholecystectomy serves the unequivocal identi?cation of the cystic duct before transection. The aim of this manuscript is to discuss classical pitfalls and bile duct injury avoiding strategies in laparoscopic cholecystectomy, by presenting an interesting case report. PRESENTATION OF CASE: A 71-year-old patient, who previously suffered from a biliary pancreatitis underwent laparoscopic cholecystectomy after ERCP with stone extraction. The intraoperative situs showed a shrunken gallbladder. After placement of four trocars, the gall bladder was grasped in the usual way at the fundus and pulled in the right upper abdomen. Following the dissection of the triangle of Calot, a “critical view of safety” was established. As dissection continued, it however soon became clear that instead of the cystic duct, the common bile duct had been dissected. In order to create an overview, the gallbladder
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