During the annual Kelly and Carlos Pellegrini SSAT and SAGES Luncheon Symposium on Tuesday, a panel of experts will discuss strategies to limit bile duct injuries that result from laparoscopic cholecystectomies. The three-hour symposium, Achieving Safety in Gallbladder Surgery, will bring attention to a procedure that, on the surface at least, deserves a new approach.

“The laparoscopic cholecystectomy is probably the most common procedure that general surgeons perform. We perform about 750,000 of these operations each year,” said SAGES Program Committee Chair Jon C. Gould, MD, chief of general surgery and vice chair for quality in the department of surgery at the Medical College of Wisconsin, Milwaukee. “It’s a relatively mature procedure, but despite all the advances in technology and despite the fact that an entire generation of surgeons has known nothing but lap choles, injuries to the biliary system still happen, and they happen at a rate that has not declined over time. In fact, the injury rate has gone up a little bit.”

Dr. Gould said Tuesday’s expert panel will examine why these injuries continue to occur and highlight opportunities to fix this ongoing problem.

“This procedure is so common and has been around so long that maybe people aren’t giving it the respect or the thought it deserves,” he said. “How do we think about this operation differently and prevent these injuries from occurring?”

The symposium will include a renewed look at the “critical view of safety” concept.

“The idea of attaining a critical view of safety during laparoscopic cholecystectomy has been around a while, but it’s not something that surgeons usually do as a matter of routine,” Dr. Gould said. “This practice uses a step-wise approach to identify the anatomy, which helps the surgeon be more certain that the duct they need is, in fact, the one they think it is. Again, this is not a new concept, but reviewing it will hopefully provide surgeons a framework for how to think about identifying the anatomy a little bit differently.”

SSAT Program Committee Chair Michael G. House, MD, associate professor of surgery at Indiana University School of Medicine, Indianapolis, said the anatomy discussion will include a review of routine versus selective cholangiography, and a look at novel intraoperative imaging modalities that can help surgeons recognize variability in bile duct anatomy.

The symposium’s presenters will also offer strategies for dealing with difficult cases, including situations where a patient needs urgent surgery due to inflammation. The panelists will also review the course of action in a worst-case scenario — an injury to the bile duct during surgery.

Please refer to the DDW Mobile App or the Program section in Tuesday’s issue for additional details on this and other DDW^® events.