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September 1991

Laparoscopic Cholecystectomy: Technique More Important Than Tool

Author Affiliations

Burlington, Mass

Arch Surg. 1991;126(9):1161. doi:10.1001/archsurg.1991.01410330123022

To the Editor.—We read with interest the commentary by Easter and Moossa1 in the April 1991 issue of the Archives concerning laser and laparoscopic cholecystectomy. We agree with their cautionary note regarding the controlled rate at which new treatments and technologies should be learned before being broadly applied; in this instance, lasers and laparoscopic cholecystectomy. However, we must take issue with their conclusion that bile duct injury during laparoscopic cholecystectomy can be blamed on lasers. The authors cite their own experience of having reconstructed the biliary tract in six patients for ductal injuries sustained during laparoscopic cholecystectomy. In five of the patients, lasers had been used. The authors commented on the remarkable absence of tissue between the ends of the remaining proximal and distal ducts, suggesting it had been "vaporized."

In contrast to the experience of Easter and Moossa, the majority of patients referred to our institution with