title: Instilling a culture of safety for laparoscopic cholecystectomy.
abstract: Laparoscopic cholecystectomy (LC) is the preferred and most widely used method for removal of the gallbladder in patients with symptomatic cholelithiasis. Modern laparoscopic equipment provides better illumination and definition with the most recent generation processors and cameras offering the possibility of 3D visualization. The minimal access approach results in smaller wounds, less postoperative pain, faster recovery, shorter hospital stay and ultimately a better cosmetic result.1 The major disadvantage of LC, however, is the biliary complications associated with the procedure, the most serious of which is a major bile duct injury (BDI).2 Although the technique was introduced more than two decades ago, the incidence of BDIs has not decreased and still occurs in 0.4% of operations, a figure twice as high as recorded during the era of open cholecystectomy.3 A recent Swedish population-based study reporting a BDI rate of 1.5% suggests that the rates in the literature may be an underestimation, or more alarmingly, that BDI rates are increasing.
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology and HPB Unit, Groote Schuur Hospital, Observatory; Netcare University of Cape Town Private Academic Hospital.
authors.forename: J E J
authors.initials: JE
authors.lastname: Krige
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology and HPB Unit, Groote Schuur Hospital, Observatory; Netcare University of Cape Town Private Academic Hospital.
authors.forename: E
authors.initials: E
authors.lastname: Jonas
authors.affiliation: Division of Surgery, University of Stellenbosch Faculty of Medicine and Health Sciences, Surgical Gastroenterology Unit, Tygerberg Academic Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Hofmeyr