[Iatrogenic lesions of the common bile duct in laparoscopic cholecystectomy: three fundamental requirements for their prevention].
Laparoscopic cholecystectomy has become the gold standard in the treatment of benign biliary disease. Common bile duct injuries are the most serious and feared complications of laparoscopic cholecystectomy, since they cause substantial morbidity and increased hospital stay, and increasingly often are the subject of legal disputes. The causes of these kinds of lesions, according to the international literature, are usually inadequate normal and pathological anatomical knowledge, an incomplete learning curve, inadequate surgical technique, and lastly insufficient compliance of the surgeon. Another important, though underestimated, role in the aetiology of these lesions is played by the human factor, and particularly by a peculiar preconceived attitude. The latter manifests itself as a lack of realism, reasonableness and morality. These three basic requirements are part of universal human experience in the dynamics of knowing and, although not statistically quantifiable, may play a role comparable to that of the technical quality of the surgical performance. In our study we have tried to show, with regard to the prevention of biliary lesions during laparoscopic cholecystectomy, the extent of the importance of these three requirements in the dynamics of knowing, particularly in laparoscopic surgery, where they are not adequately taken into consideration. The analysis of the profound interaction between these requisites and surgical practice may allow correct identification of this preconceived attitude on the part of the operator, which can be avoided or minimized only through appropriate surgical training.
Tuveri
Massimiliano
M
Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari.
Pisu
Salvatore
S
Demontis
Roberto
R
Medas
Fabio
F
Nicolosi
Angelo
A
D001649:Bile Duct Diseases / Q000209:etiology / Q000517:prevention & control*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002983:Clinical Competence; D003135:Common Bile Duct / Q000293:injuries*; D004502:Education, Medical, Continuing; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*