title: Current practices in biliary surgery: Do we practice what we teach?
abstract: Since the widespread adoption of laparoscopic techniques in biliary surgery, the incidence of bile duct injures (BDI) has not significantly declined despite increased operative experience and recognition of the critical view of safety (CVS) method for anatomic identification. We hypothesized that operative approaches in clinical practice may vary from well-described technical recommendations. The objective of this study was to access how practicing surgeons commonly identify anatomy during laparoscopic cholecystectomy (LC).
  
  
  
  We performed a cohort study assessing practices in biliary surgery among current practicing surgeons. Surgeons belonging to the Midwest Surgical Association and the Society of American Gastrointestinal and Endoscopic Surgeons were surveyed. Items surveyed include preferred methods for cystic duct identification, recognition of the CVS, and use of intraoperative imaging.
  
  
  
  In total, 374 of 849 surgeons responded. The CVS was not correctly identified by 75 % of surgeons descriptively and by 21 % of surgeons visually. 56 % of surgeons practiced the infundibular method for identification of the cystic duct; 27 % practiced the CVS method. Intraoperative cholangiography was used by 16 % and laparoscopic ultrasound by <1 %.
  
  
  
  A majority of surgeons preferably do not use the CVS method of identification during LC. A large percentage of practicing surgeons are unable to describe or visually identify the CVS. These results suggest an urgent need to reexamine the tenets of how LC is being taught and disseminated and present a clear target for improvement to reduce BDI.
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA. Shaun_Daly@rush.edu.
authors.forename: Shaun C
authors.initials: SC
authors.lastname: Daly
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Deziel
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA.
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA.
authors.forename: Milot
authors.initials: M
authors.lastname: Thaqi
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA.
authors.forename: Keith W
authors.initials: KW
authors.lastname: Millikan
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Myers
authors.affiliation: John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Bonomo
authors.affiliation: Rush University Medical Center, 1725 West Harrison Street, Suite 810, Chicago, IL, 60612, USA.
authors.forename: Minh B
authors.initials: MB
authors.lastname: Luu
mesh_terms: D000328:Adult; D002758:Cholangiography / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data; D014481:United States
keywords: Common bile duct; Critical view; Injury; Safety