ABSTRACT
Over 750,000 cholecystectomies are performed annually in the United States. During this operation, the surgeon divides the cystic duct, which joins the gallbladder to the common bile duct (CBD), and also divides the cystic artery (Figure 21.1). In rare instances, damage to the CBD or other biliary or arterial structures in the area can occur, with potentially serious consequences. The most commonly injured structures are the CBD and common hepatic duct. Consequences of such injuries are significant; the body cannot function without these two structures, and patients must undergo surgery for repair. The right hepatic artery runs posterior to the CBD (Figure 21.1) and can also be injured if the CBD is transected or injured. The incidence of major bile duct injury is greater during laparoscopic cholecystectomy (0.5%) than during open cholecystectomy (0.1 to 0.2%) (Adamson et al., 1997; Davidoff et al., 1992; Deziel et al., 1993). There are important differences between the open and laparoscopic procedures. With open procedures the surgeons have direct visibility and access to the operative area, while with laparoscopic procedures the operation is done using instruments inserted through small (<1 cm) ports in the abdominal wall. A camera is attached to one of the ports and the anatomy is viewed on a video monitor. This results in a more limited view of the anatomy as well as loss of haptic input.
