NIH Press Release

Lectric Law Summary
NIH Press Release
Abstract of NIH Study & Link

Lectric Law Library (www.lectlaw.com) summarized the issues surrounding laparoscopic cholecystectomy and the NIH conference as follows:

“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)