Moving the needle for laparoscopic common bile duct exploration: defining obstacles for the path forward

Area of Science:

• Minimally invasive surgery
• Gastrointestinal surgery
• Surgical innovation

Background:

• Laparoscopic cholecystectomy is common, but laparoscopic common bile duct exploration (LCBDE) is infrequent.
• Significant barriers hinder the widespread adoption of LCBDE.
• Identifying these barriers is crucial for improving surgical practice.

Purpose of the Study:

• To determine the primary barriers preventing surgeons from performing LCBDE.
• To identify effective interventions that can promote the adoption of LCBDE.

Main Methods:

• A national survey was distributed to members of the Society of American Gastrointestinal and Endoscopic Surgeons and the American Association for the Surgery of Trauma.
• Content experts designed the survey to assess LCBDE practices and perceived barriers.
• Descriptive statistics were used to analyze responses from US surgeons.

Main Results:

• Only 27% of surgeons preferred LCBDE for choledocholithiasis management, with choledochoscopy being the preferred technique.
• A significant portion of surgeons lacked access to choledochoscopes (36%) or readily available supplies (70%).
• Many surgeons were unaware of reimbursement (75% unaware) and perceived time constraints, despite recognizing LCBDE's benefit of shorter hospital stays.

Conclusions:

• Low LCBDE utilization stems from multiple barriers, including equipment availability and supply chain issues.
• Increasing access to equipment, dedicated supply carts, and training can enhance LCBDE adoption.
• Addressing financial அறியாமை and perceived time/skill limitations is essential for improving patient care and reducing healthcare costs through increased LCBDE use.