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Guimarães A, Lemos M, Donato P, Bernardes A. Treatment of complex iatrogenic common hepatic duct injury following laparoscopic cholecystectomy. BMJ Case Rep 2023; 16:e254394. [PMID: 38081736 PMCID: PMC10729077 DOI: 10.1136/bcr-2022-254394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
We report the case of a woman in her 40s, with no significant medical history, submitted to a laparoscopic cholecystectomy in our institution for symptomatic gallbladder lithiasis. On postoperative day 4, she presented to our emergency room with severe abdominal pain and elevated inflammatory markers. Abdominal CT scan revealed a mass filled with liquid and air in the gallbladder fossa. Surgical exploration was performed revealing a major common hepatic duct iatrogenic injury, which was managed using suture over a T-tube. Three months after surgery, cholangiography showed a biliary stenosis, and a biodegradable stent was inserted through percutaneous transhepatic access. The difficulties in the management of this condition and its outcomes are discussed in this report.
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Affiliation(s)
- Andreia Guimarães
- General Surgery, Centro Hospital e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Mariana Lemos
- General Surgery, Centro Hospital e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Paulo Donato
- Radiology, Centro Hospital e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - António Bernardes
- General Surgery, Centro Hospital e Universitário de Coimbra, EPE, Coimbra, Portugal
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Promoting the Critical View of Safety for Safe Laparoscopic Cholecystectomy: Notes on Awareness and Correct Implementation. J Am Coll Surg 2022; 234:1262-1263. [PMID: 35703832 DOI: 10.1097/xcs.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Nwoye CI, Yu T, Gonzalez C, Seeliger B, Mascagni P, Mutter D, Marescaux J, Padoy N. Rendezvous: attention mechanisms for the recognition of surgical action triplets in endoscopic videos. Med Image Anal 2022; 78:102433. [DOI: 10.1016/j.media.2022.102433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Vannucci M, Laracca GG, Mercantini P, Perretta S, Padoy N, Dallemagne B, Mascagni P. Statistical models to preoperatively predict operative difficulty in laparoscopic cholecystectomy: A systematic review. Surgery 2021; 171:1158-1167. [PMID: 34776259 DOI: 10.1016/j.surg.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy operative difficulty is highly variable and influences outcomes. This systematic review analyzes the performance and clinical value of statistical models to preoperatively predict laparoscopic cholecystectomy operative difficulty. METHODS PRISMA guidelines were followed. PubMed, Embase, and the Cochrane Library were searched until June 2020. Primary studies developing or validating preoperative models predicting laparoscopic cholecystectomy operative difficulty in cohorts of >100 patients were included. Studies not reporting performance metrics or enough information for clinical implementation were excluded. Data were extracted according to CHARMS, and study quality was assessed using the PROBAST tool. RESULTS In total, 2,654 articles were identified, and 22 met eligibility criteria. Eighteen were model development, whereas 4 were validation studies. Eighteen studies were at high risk of bias. However, 11 studies showed low concern for applicability. Identified models predict 9 definitions of laparoscopic cholecystectomy operative difficulty, the most common being conversion to open surgery and operating time. The most validated models predict an intraoperative difficulty scale and procedures >90 minutes with an area under the curve of >0.70 and >0.76, respectively. Commonly used predictors include demographic variables such as age and gender (9/18 models) and ultrasound findings such as gallbladder wall thickness (11/18). Clinical implementation was never studied. CONCLUSION There is a longstanding interest in estimating laparoscopic cholecystectomy operative difficulty. Models to preoperatively predict laparoscopic cholecystectomy operative difficulty have generally good performance and seem applicable. However, an unambiguous definition of operative difficulty, validations, and clinical studies are needed to implement patients' stratification in laparoscopic cholecystectomy.
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Affiliation(s)
- Maria Vannucci
- University of Tor Vergata, Rome, Italy; Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
| | - Giovanni Guglielmo Laracca
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Paolo Mercantini
- Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Silvana Perretta
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France; Department of Digestive and Endocrine Surgery, University of Strasbourg, France
| | - Nicolas Padoy
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France; ICube, University of Strasbourg, CNRS, Illkirch, France
| | - Bernard Dallemagne
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; Department of Digestive and Endocrine Surgery, University of Strasbourg, France
| | - Pietro Mascagni
- Institute of Image-Guided Surgery, Institut Hospitalo-Universitaire (IHU), Strasbourg, France; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Conversion from laparoscopic to open cholecystectomy: Risk factor analysis based on clinical, laboratory, and ultrasound parameters. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:363-369. [PMID: 34384723 DOI: 10.1016/j.rgmxen.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/19/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND AIMS The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.
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Mascagni P, Rodríguez-Luna MR, Urade T, Felli E, Pessaux P, Mutter D, Marescaux J, Costamagna G, Dallemagne B, Padoy N. Intraoperative Time-Out to Promote the Implementation of the Critical View of Safety in Laparoscopic Cholecystectomy: A Video-Based Assessment of 343 Procedures. J Am Coll Surg 2021; 233:497-505. [PMID: 34325017 DOI: 10.1016/j.jamcollsurg.2021.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The critical view of safety (CVS) is poorly adopted in surgical practices although it is ubiquitously recommended to prevent major bile duct injuries during laparoscopic cholecystectomy (LC). This study aims to investigate whether performing a short intraoperative time out can improve CVS implementation. STUDY DESIGN In this before versus after study, surgeons performing LCs at an academic center were invited to use a 5-second long time out to verify CVS before dividing the cystic duct (5-second rule). The primary aim was to compare the rate of CVS achievement for LCs performed in the year before versus the year after implementation of the 5-second rule. The CVS achievement rate was computed after exclusion of bailout procedures using a mediated video-based assessment made by two independent reviewers. Clinical outcomes, LC workflows, and postoperative reports were also compared. RESULTS 343 of the 381 LCs performed between December 2017 and November 2019 (171 before and 172 after implementation of the 5-second rule) were analyzed. The 5-second rule was associated with a significantly increased rate of CVS achievement (15.9 vs. 44.1% before vs. after the 5-second rule, respectively; P<0.001). Significant differences were also observed with respect to the rate of bailout procedures (8.2 vs. 15.7%; P=0.04), the median [IQR] time to clip the cystic duct or artery (00:17:26 [00:11:48, 00:28:35] vs. 00:23:12 [00:14:29, 00:31:45] duration; P=0.007), and the rate of postoperative CVS reporting (1.3 vs. 28.8%; P<0.001). Postoperative morbidity was comparable (1.8 vs. 2.3%; P=0.68). CONCLUSION Performing a short intraoperative time out was associated with an improved CVS achievement rate. Systematic intraoperative cognitive aids should be studied to sustain the uptake of guidelines.
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Affiliation(s)
- Pietro Mascagni
- ICube, University of Strasbourg, CNRS, IHU Strasbourg, France; Gastrointestinal Endoscopic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | | | - Takeshi Urade
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Emanuele Felli
- Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
| | - Patrick Pessaux
- Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
| | - Didier Mutter
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
| | - Guido Costamagna
- Gastrointestinal Endoscopic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Center for Endoscopic Research, Therapeutics and Training (CERTT), Università Cattolica S. Cuore, Rome, Italy
| | - Bernard Dallemagne
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France; IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Department of Digestive and Endocrine Surgery, University of Strasbourg, Strasbourg, France
| | - Nicolas Padoy
- ICube, University of Strasbourg, CNRS, IHU Strasbourg, France; IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
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OR black box and surgical control tower: Recording and streaming data and analytics to improve surgical care. J Visc Surg 2021; 158:S18-S25. [PMID: 33712411 DOI: 10.1016/j.jviscsurg.2021.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Effective and safe surgery results from a complex sociotechnical process prone to human error. Acquiring large amount of data on surgical care and modelling the process of surgery with artificial intelligence's computational methods could shed lights on system strengths and limitations and enable computer-based smart assistance. With this vision in mind, surgeons and computer scientists have joined forces in a novel discipline called Surgical Data Science. In this regard, operating room (OR) black boxes and surgical control towers are being developed to systematically capture comprehensive data on surgical procedures and to oversee and assist during operating rooms activities, respectively. Most of the early Surgical Data Science works have focused on understanding risks and resilience factors affecting surgical safety, the context and workflow of procedures, and team behaviors. These pioneering efforts in sensing and analyzing surgical activities, together with the advent of precise robotic actuators, bring surgery on the verge of a fourth revolution characterized by smart assistance in perceptual, cognitive and physical tasks. Barriers to implement this vision exist, but the surgical-technical partnerships set by ambitious efforts such as the OR black box and the surgical control tower are working to overcome these roadblocks and translate the vision and early works described in the manuscript into value for patients, surgeons and health systems.
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Morales-Maza J, Rodríguez-Quintero JH, Santes O, Aguilar-Frasco JL, Romero-Vélez G, García-Ramos ES, Sánchez-Morales G, León P, Pastor-Sifuentes FU, Terán-Ellis SMY, Álvarez-Bautista F, Clemente-Gutiérrez U, Mercado-Díaz MA. Conversion from laparoscopic to open cholecystectomy: Risk factor analysis based on clinical, laboratory, and ultrasound parameters. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 86:S0375-0906(20)30131-2. [PMID: 33358491 DOI: 10.1016/j.rgmx.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/30/2020] [Accepted: 07/19/2020] [Indexed: 12/07/2022]
Abstract
INTRODUCTION AND AIMS The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.
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Affiliation(s)
- J Morales-Maza
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | | | - O Santes
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - J L Aguilar-Frasco
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - G Romero-Vélez
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, EE. UU
| | - E Sánchez García-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - G Sánchez-Morales
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - P León
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - F U Pastor-Sifuentes
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - S Mier Y Terán-Ellis
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - F Álvarez-Bautista
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - U Clemente-Gutiérrez
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - M A Mercado-Díaz
- Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
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Gupta V. Vanishing Calot Syndrome: Common Face of Many Problems. J Am Coll Surg 2020; 231:187-188. [PMID: 32389576 DOI: 10.1016/j.jamcollsurg.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/15/2022]
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Lubikowski J, Piotuch B, Stadnik A, Przedniczek M, Remiszewski P, Milkiewicz P, Silva MA, Wojcicki M. Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature. BMC Surg 2019; 19:162. [PMID: 31694627 PMCID: PMC6833182 DOI: 10.1186/s12893-019-0619-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Background Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. Case presentation Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. Conclusion We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.
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Affiliation(s)
- Jerzy Lubikowski
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland.,Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, M. Curie Hospital, Szczecin, Poland
| | - Bernard Piotuch
- Department of Surgery, Ministry of the Interior and Administration Hospital, Szczecin, Poland.,Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Anna Stadnik
- Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Przedniczek
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Remiszewski
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland.,Translational Medicine Group, Pomeranian Medical University, Szczecin, Poland
| | - Michael A Silva
- Department of Hepatobiliary and Pancreatic Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maciej Wojcicki
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland.
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Conclusive Identification and Division of the Cystic Artery: A Forgotten Trick to Optimize Exposure of the Critical View of Safety in Laparoscopic Cholecystectomy. J Am Coll Surg 2019; 229:e5-e7. [DOI: 10.1016/j.jamcollsurg.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 12/24/2022]
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