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Current practices in biliary surgery: Do we practice what we teach?

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Abstract

Introduction

Since the widespread adoption of laparoscopic techniques in biliary surgery, the incidence of bile duct injures (BDI) has not significantly declined despite increased operative experience and recognition of the critical view of safety (CVS) method for anatomic identification. We hypothesized that operative approaches in clinical practice may vary from well-described technical recommendations. The objective of this study was to access how practicing surgeons commonly identify anatomy during laparoscopic cholecystectomy (LC).

Methods

We performed a cohort study assessing practices in biliary surgery among current practicing surgeons. Surgeons belonging to the Midwest Surgical Association and the Society of American Gastrointestinal and Endoscopic Surgeons were surveyed. Items surveyed include preferred methods for cystic duct identification, recognition of the CVS, and use of intraoperative imaging.

Results

In total, 374 of 849 surgeons responded. The CVS was not correctly identified by 75 % of surgeons descriptively and by 21 % of surgeons visually. 56 % of surgeons practiced the infundibular method for identification of the cystic duct; 27 % practiced the CVS method. Intraoperative cholangiography was used by 16 % and laparoscopic ultrasound by <1 %.

Conclusion

A majority of surgeons preferably do not use the CVS method of identification during LC. A large percentage of practicing surgeons are unable to describe or visually identify the CVS. These results suggest an urgent need to reexamine the tenets of how LC is being taught and disseminated and present a clear target for improvement to reduce BDI.

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Acknowledgments

Institutional support from Rush University Medical Center was provided for this work.

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Authors and Affiliations

  1. Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA

    Shaun C. Daly, Daniel J. Deziel, Xuan Li, Milot Thaqi, Keith W. Millikan, Jonathan A. Myers & Minh B. Luu

  2. John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA

    Steven Bonomo

Authors
  1. Shaun C. Daly
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  2. Daniel J. Deziel
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  3. Xuan Li
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  4. Milot Thaqi
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  8. Minh B. Luu
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Corresponding author

Correspondence to Shaun C. Daly.

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Disclosures

Shaun C. Daly has no conflicts of interest. Xuan Li has no conflicts of interest. Milot Thaqi has no conflicts of interest. Keith W. Millikan has no conflicts of interest. Daniel J. Deziel has no conflicts of interest. Jonathan A. Myers has no conflicts of interest. Steven Bonomo has no conflicts of interest. Minh B. Luu has no conflicts of interest.

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Daly, S.C., Deziel, D.J., Li, X. et al. Current practices in biliary surgery: Do we practice what we teach?. Surg Endosc 30, 3345–3350 (2016). https://doi.org/10.1007/s00464-015-4609-8

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  • DOI: https://doi.org/10.1007/s00464-015-4609-8

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