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October 19, 2009

Patient Safety in Laparoscopic Cholecystectomy

Arch Surg. 2009;144(10):977-980. doi:10.1001/archsurg.2009.180

Fluorescent cholangiography improves outcomes of LC.1 Fluorescent cholangiography is a welcome addition to the surgical tools available for the “new world of patient safety,”2 helping to deliver the best to all patients, all the time. Bile duct injury–prevention strategies focus on avoiding misidentification of biliary anatomy owing to misperception. Structured granting of professional privileges, judicious avoidance of energized dissection, and the systems approach have helped,3 but the risk of human error2 due to spatial disorientation leading to psychoheuristic cognitive ambiguity continues to haunt the BDI-fearing surgeon.4 Risk of error is high in LC because the operator does not manipulate reality directly but works from images.4 This video-perceptive illusion, ie, error of perception from working indirectly, is disastrous. Even minor errors may result in BDI. Fluorescent cholangiography neither needs additional resources (besides an optic filter) nor increases the invasiveness of LC.1 Fluorescent cholangiography facilitates the clear interpretation of biliary anatomy. It minimizes cognitive error by allowing surgeons to believe what they see rather than trying to see what they believe. Fluorescent cholangiography pre-empts any possibility of video-perceptive heuristics going wrong. It augments the cognitive skill of physicians, enabling them to execute surgical movements as planned and envisioned mentally.

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