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Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist
Saxon J Connor1, William Perry, Leslie Nathanson
1Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
Objectives:
Prevalences of bile duct injury (BDI) following laparoscopic cholecystectomy (LC) remain unacceptably high. There is no standardized method for performing an LC. This study aims to describe a standardized technique for LC that will allow for the development of a concept LC checklist, the use of which, it is hoped, will decrease the prevalence of BDI.
Methods:
A standardized method for LC was developed based on previously published expert analysis supplemented by video error analysis of operations in which BDI occurred. Established checklist methodology was then used to construct an LC-specific concept checklist.
Results:
A five-step technique for the safe establishment of the critical view was created to guide the development of the checklist. The five steps are: (i) confirm the gallbladder lies in the hepatic principal plane and is retracted to the 10 o'clock position; (ii) confirm Hartmann's pouch is lifted up and toward the segment IV pedicle; (iii) identify Rouvière's sulcus; (iv) confirm the release of the posterior leaf of the peritoneum covering the hepatobiliary triangle, and (v) confirm the critical view with or without intraoperative cholangiography.
Conclusions:
A standardized approach to LC would allow for the creation of an LC-specific checklist that has the potential to lower the prevalence of BDI.