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Invited Critique
August 14, 2009

Single-Incision Laparoscopic Cholecystectomy Using a Flexible Endoscope—Invited Critique

Arch Surg. 2009;144(8):738-739. doi:10.1001/archsurg.2009.130

Laparoscopic cholecystectomy revolutionized not only surgery but all of health care. Its development is also a study in how medicine can be transformed against the best advice of content experts. The first 100 LC operations were performed using rigid cystoscopy instrumentation by Eric Mühe, MD, in Germany. Because of severely limited exposure, the operation was considered dangerous and Dr Mühe was severely criticized by his colleagues. Shortly thereafter, the French developed a videoscopic approach to the operation that was somewhat better but still not well accepted by the surgical community. Experts in biliary surgery were concerned about the lack of exposure and the potential for serious bile duct injuries. They predicted that this new approach was a fad and would disappear once the higher complication rate become evident. The first publications describing the new approach reported a bile duct injury rate that was 10-fold higher than expected, whereupon the experts anticipated the early demise of LC.

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