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Related Experiment Videos

Laparoscopic biliary injury: more than a learning curve problem

J A Windsor1, J Pong

  • 1Surgical Skills Training Centre, Department of Surgery, Faculty of Medicine and Health Science, University of Auckland, New Zealand. j.windsor@auckland.ac.nz

The Australian and New Zealand Journal of Surgery
|May 1, 1998
PubMed
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Iatrogenic biliary injuries after laparoscopic cholecystectomy remain a persistent problem in New Zealand. Despite increased surgeon experience, the incidence of these injuries has not decreased, highlighting the need for improved training and technique.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Safety

Background:

  • Laparoscopic cholecystectomy (LC) introduction led to increased iatrogenic injury to the extrahepatic biliary tree.
  • This increase was initially attributed to a 'learning curve' phenomenon.
  • Previous New Zealand experience with LC and its associated injuries has been documented.

Purpose of the Study:

  • To assess changes in the incidence, nature, and management of laparoscopic biliary injuries (LBI) in New Zealand.
  • To determine if further experience with LC has impacted LBI rates.
  • To evaluate trends in LBI diagnosis and treatment.

Main Methods:

  • A nationwide audit conducted in 1995 using confidential postal questionnaires.
  • Surveys distributed to 184 active general surgeons (60% response rate).

Related Experiment Videos

  • Surveys distributed to 18 endoscopists performing ERCP (100% response rate).

    • Main Results:

    • 21 LBI reported, a decrease from 41 in 1991-92, but incidence in the subset of responsible surgeons remained stable (2.8% vs 2.9%).
    • Injury site and nature were similar between survey periods.
    • Delayed diagnosis increased (25% vs 47%), with less frequent ERCP use (76% vs 65%) and more re-operations for minor injuries (26% vs 50%).

    Conclusions:

    • Iatrogenic biliary injury is an ongoing issue in New Zealand despite increased LC experience.
    • The findings suggest a need for enhanced scrutiny of surgical techniques and training.
    • Conservative management of minor duct injuries should be explored further.