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Resident's Forum
January 2010

The Pedicle Effect and Direct Coupling: Delayed Thermal Injuries to the Bile Duct After Laparoscopic Cholecystectomy

Author Affiliations

Author Affiliations: Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, England.



Arch Surg. 2010;145(1):96-98. doi:10.1001/archsurg.2009.236

Electrothermal energy, especially in the form of monopolar diathermy, is used widely for dissection during laparoscopic cholecystectomy. While this is largely safe, occasionally there can be unrecognized transfer of energy in the operating area, resulting in electrothermal injury. We report a series of 3 patients who underwent uneventful laparoscopic cholecystectomies but were readmitted 4 to 5 days later with pinhole leaks from the common bile duct as a result of coagulative necrosis caused by unrecognized energy transfer. We suggest that surgeons keep the use of monopolar diathermy to a minimum while dissecting near vital structures.