Three-dimensional identification of the cystic infundibulum-cystic duct junction: a technique for identification of the cystic duct in laparoscopic cholecystectomy.
OBJECTIVE
The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i.e., three-dimensional identification of the cystic infundibulum (CI)-CD junction, to prevent misidentification-induced BDI during laparoscopic cholecystectomy.


METHODS
The CI was extensively dissected to expose its anterior, interior-superior and inferior-dorsal aspects. With the CI nearly circularly dissected out, the CI and the appearance-indicated CI-CD junction might be three-dimensionally identified and the reality of the CI-CD junction as well as the reality of the CD could be precisely judged.


RESULTS
Overall 10 BDIs were documented in this group. Since BDI occurred in 8 of 4382 patients receiving laparoscopic cholecystectomy, the technique for prevention of misidentification-induced BDI was established. Among the late batch of 7618 patients, only two BDIs were noted.


CONCLUSIONS
Three-dimensional identification of the CI-CD junction is a reliable, feasible and relatively low experience-dependent technique to prevent most of misidentification-induced BDI.
Department of Hepatobiliary Surgery, Kunming General Hospital of PLA, Kunming 650032, China. diglower@sohu.com
Ding
D
Luo
Xun-Ru
XR
Chen
Jing-Xi
JX
Mao
Sheng-Hong
SH
Li
Zheng-Dong
ZD
Zhou
Shao-Ming
SM
Yu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003135:Common Bile Duct / Q000033:anatomy & histology*; D003549:Cystic Duct / Q000033:anatomy & histology* / Q000601:surgery*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged