Bile duct injury in cholecystectomy usually comes from misidentification, not technical error. The critical view of safety requires three things: the hepatocystic triangle cleared of fat and fibrous tissue, the lower third of the gallbladder separated from the liver bed, and only two structures entering the gallbladder.
If the view cannot be obtained in a severely inflamed gallbladder, stop dissecting in the triangle. A subtotal cholecystectomy, fundus-first approach, cholecystostomy or conversion are all safer than pressing on, and they should be planned as legitimate outcomes, not treated as failures.
- Confirm all three components of the critical view of safety before clipping anything
- Take a photograph or video still of the view for the record
- If the view cannot be achieved, choose a bailout rather than continued dissection
- Call a second surgeon early in a difficult gallbladder
Why it matters
Most bile duct injuries happen when a surgeon continues without a secure view.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free