Laparoscopic Bile Duct Injury Prevention and Management

Laparoscopic injury to the bile ducts remains a serious complication of cholecystectomy, with potential for significant morbidity, mortality and long-term impairment of quality of life. Prevention hinges on meticulous dissection within Calot’s triangle to achieve the critical view of safety, supplemented by intraoperative imaging modalities when anatomy is unclear. Techniques such as intraoperative cholangiography and fluorescence cholangiography with indocyanine green enhance visualisation of biliary anatomy, reducing misidentification of ducts. Early recognition of injury—either during the index procedure or in the immediate postoperative period—is vital to permit timely multidisciplinary management. Classification systems guide repair strategy, which may range from endoscopic stenting and percutaneous techniques to surgical reconstruction. Standardised training programmes, adherence to safety protocols and decision algorithms for difficult cases are key to minimising injury rates and optimising outcomes on a global scale.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Laparoscopic Bile Duct Injury Prevention and Management publication trend

The graph below shows the total number of articles in laparoscopic bile duct injury prevention and management across all publications each year (not limited to Nature Index journals).

Technical terms

Calot’s triangle: An anatomical space bounded by the cystic duct, common hepatic duct and lower margin of the liver, targeted in dissection to identify key biliary structures.

Critical view of safety (CVS): A surgical technique ensuring only two structures (cystic duct and artery) enter the gallbladder before transection, reducing misidentification errors.

Indocyanine green fluorescence cholangiography: A real-time imaging method using intravenous dye and near-infrared light to delineate bile ducts without ionising radiation.

Near-infrared imaging: The use of NIR light to excite fluorescent agents, permitting enhanced visualisation of anatomical structures during minimally invasive surgery.

References

1. Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surgical Endoscopy (2016).
2. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World Journal of Emergency Surgery (2021).
3. Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy. Medicine (2015).
4. Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure. Surgical Endoscopy (2020).
5. Extrahepatic biliary tract visualization using near-infrared fluorescence imaging with indocyanine green: optimization of dose and dosing time. Surgical Endoscopy (2020).