“Early
in the national experience with laparoscopic
cholecystectomy it became apparent that some surgeons who were in
the early phases of their training would misidentify
the anatomy and inadvertently clip and divide the
common bile duct thinking it to be the cystic duct.
In many instances this would result in complete obstruction
of the common bile duct, which would require a second
operation to correct. Often these injuries were not
noted at the time of the initial procedure and therefore
a delay in the diagnosis of the problem often resulted.
Other
problems of much less consequence have also been identified
to occur following laparoscopic cholecystectomy. This
includes entering the gall bladder and spilling stones
and bile into the peritoneal cavity, failure to diagnose
stones in the common bile duct, cystic duct clips
falling off leading to bile peritonitis, holes being
poked in the cystic dust while doing x-rays of the
biliary tree (cholangiography), holes poked into the
intestine or mesentery by either the needle used to
fill the peritoneum with CO2 (Verness needle) or one
of the trocars used to introduce the ports.”
"The
results of this consensus conference were less than
definitive except that it was decided that laparoscopic
cholecystectomy is a worthwhile procedure that can
be done safely given proper training, supervision
and experience and:
a)
That a learning curve existed and once a particular
surgeon performed 25 - 50 laparoscopic cholecystectomies
the incidence of common bile duct injuries greatly
decreased.
b) That routine x-rays of the bile duct (cholangiography)
was not a necessary part of this procedure.
c) That conversion to an open procedure from a laparoscopic procedure should be done whenever there is any question
concerning anatomy.
d) That the incidence of common bile duct injuries
following laparoscopic procedures should be the same
or close to that of open procedures.
Minimally
invasive surgery represents a great step forward in
the field of general surgery; however, there is no
reason to sacrifice safety in its performance. The
standard to which things can be compared is the same
as the operation done in the traditional open fashion.
Complications which commonly occur during open procedures
can also be expected following laparoscopic procedures.
Unfortunately
no recommendations were made at the conference concerning
credentialing. Although certain observations
were made concerning learning curves, individual hospitals
were left with the responsibility of monitoring and
regulating surgeons at their individual facilities.
Hence significant differences exist from institution
to institution concerning requirements for credentialing
for individual surgeons to do specific laparoscopic
procedures. This circumstance continues today and
probably will not change in the near future.”
*This
article is presented and copyrighted by The 'Lectric
Law Library and Dr. Steven E. Lerner & Associates
(www.drlerner.com)
