• difficult laparoscopic cholecystectomy
• general surgery
• hepato-pancreato-biliary surgery
• laparoscopic cholecystectomy complication
• short cystic duct

• Bile spillage
• Gall bladder cancer
• Survival

• Humans
• Gallbladder Neoplasms/mortality
• Gallbladder Neoplasms/surgery
• Gallbladder Neoplasms/pathology
• Gallbladder Neoplasms/diagnosis
• Prognosis
• Peritoneal Neoplasms/mortality
• Peritoneal Neoplasms/secondary
• Peritoneal Neoplasms/diagnosis
• Peritoneal Neoplasms/epidemiology
• Cholecystectomy/adverse effects
• Bile
• Disease-Free Survival
• Risk Factors
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality

• cholelithiasis
• chronic cholecystitis
• gallbladder
• laparoscopic cholecystectomy
• liver

• AI
• Inguinal hernia repair
• Minimally invasive surgery
• Surgical intelligence
• TEP

• Humans
• Hernia, Inguinal/surgery
• Laparoscopy/methods
• Artificial Intelligence
• Workflow
• Minimally Invasive Surgical Procedures
• Herniorrhaphy/methods
• Surgical Mesh

• Theator
• Università Politecnica delle Marche

• Acute care surgery
• Fluorescence-guided surgery
• Trauma

• Adult
• Humans
• Fluorescence
• Mesenteric Ischemia
• Surgery, Computer-Assisted
• Elective Surgical Procedures
• Cholecystitis, Acute
• Indocyanine Green

• Strasberg classification of bile duct injury
• actuarial patency rate after bile duct repair
• bile duct injury

• biliary injury
• laparoscopic cholecystectomy
• legal practice
• litigation
• postoperative complications

Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy.

A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification.

Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V.

In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

• Clavien–Dindo classification
• Complications
• Difficulty cholecystectomy
• Gallbladder
• Laparoscopic subtotal cholecystectomy

Gallstone disease is common in India, and since primary management involves surgery, it is one of the most commonly performed surgeries by a general surgeon either laparoscopically or open. There are various factors which are responsible for intra- and post-operative complications. These factors result in significant injuries which cause serious post-operative complications. Amongst them, benign biliary stricture is one such significant complication which is primarily managed by open surgery, but since advent of laparoscopy, there has been an increased interest in doing this repair laparoscopically.

This is a retrospective study of 16 patients having obstructive jaundice due to benign biliary stricture on magnetic resonance cholangiopancreatography who were operated consecutively over the past 10 years laparoscopically and underwent laparoscopic Roux-en-Y hepaticojejunostomy.

All patients underwent laparoscopic hepaticojejunostomy. The mean surgical time was 280 min, and the mean blood loss was 176 ml. In the post-operative period, most of the patients were started orally after 48 h; four had atelectasis, eight had surgical site infection, none had seroma and two had bile leak. All post-operative complications responded to conservative management.

The study demonstrates that laparoscopic surgery for benign biliary strictures is safe and feasible with acceptable results.

• Benign biliary stricture
• bile duct injury
• laparoscopic hepaticojejunostomy

• Bile duct injury (BDI)
• Laparoscopic cholecystectomy (LC)
• Misidentification
• Prevention
• Retrograde tracing

• Bile Ducts/injuries
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Cystic Duct
• Humans
• Iatrogenic Disease/prevention & control

• Bile duct injury
• Cholecystectomy
• Hepaticojejunostomy
• Stricture

• Anorectal malformation
• Imperforate anus
• Safety culture

• Bile duct injury
• Bile leak
• Cholecystectomy
• Cholecystitis
• Cholelithiasis

The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps (e.g., fundus first technique); (8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.

• Bile leak
• Bile duct injury
• Cholecystectomy
• Cholelithiasis
• Cholecystitis

• Biliary injury
• Laparoscopic cholecystectomy
• Liver cirrhosis
• Outcome of BI repair
• Sepsis

Laparoscopic cholecystectomy - associated bile duct injury is a clinical problem with bad outcome. The study aimed to analyze the outcome of surgical management of these injuries.

We retrospectively analyzed 69 patients underwent surgical management of laparoscopic cholecystectomy related major bile duct injuries in the period from the beginning of 2013 to the beginning of 2018.

Regarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular, and obstructing + vascular injuries were 43.5%, 27.5%, 18.8%, 2.9%, and 7.2% respectively. However, the Strasberg classification of injury was as follow E1 = 25, E2 = 32, E3 = 8, and E4 = 4. The definitive procedures were as follow: end to end biliary anastomosis with stenting, hepaticojejunostomy (HJ) with or without stenting, and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87%, and 8.7% of patients respectively. According to the time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5months), and late (after1.5 months) management were 13%, 14.5%, and 72.5% respectively. The hospital and/or 1month (early) morbidity after definitive treatment was 21.7%, while, the late biliary morbidity was 17.4% and the overall mortality was 2.9%, on the other hand, the late biliary morbidity-free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, right hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis, and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, reconstruction without stenting, liver cirrhosis, operative bleeding, and early morbidity.

Sepsis at referral, liver cirrhosis, and operative bleeding were significantly associated with both early and late morbidities after definitive management of laparoscopic cholecystectomy related major bile duct injuries, so it is crucial to avoid these catastrophes when doing those major procedures.

•

Sepsis at referral was associated with poor outcome after management of LC related MBDIs.

• Biliary injury
• Laparoscopic cholecystectomy
• Liver cirrhosis
• Outcome of BI repair
• Sepsis

• Minimally invasive surgical procedures
• Robotic cholecystectomy
• Single site
• Systematic review

Laparoscopic cholecystectomy is considered as the gold standard in the treatment of gallbladder disease. Laparoscopy presents significant advantages including decreased hospital stay, better aesthetic results, faster rehabilitation, less pain, reduced cost, and increased patient satisfaction. The complications' prevalence is low; however, the overall serious complication rate seems to be higher compared to open cholecystectomy, despite the increasing experience. Diaphragmatic injury following laparoscopic cholecystectomy is an extremely rare complication, and a high index of clinical suspicion is necessary to diagnose this situation that has a variety of clinical presentations and might be life-threatening. We present a unique case of postlaparoscopic cholecystectomy diaphragm defect with late onset. The clinical findings included those of respiratory distress syndrome along with small bowel incarceration and peritonitis.

• difficult gallbladder
• laparoscopic cholecystectomy
• subtotal fenestrating cholecystectomy

• Bile duct
• bile duct injury
• laparoscopic cholecystectomy

Recently major developments in video imaging have been achieved: among these, the use of high definition and 3D imaging systems, and more recently indocyanine green (ICG) fluorescence imaging are emerging as major contributions to intraoperative decision making during surgical procedures. The aim of this study was to present our experience with different laparoscopic procedures using ICG fluorescence imaging.

108 ICG-enhanced fluorescence-guided laparoscopic procedures were performed: 52 laparoscopic cholecystectomies, 38 colorectal resections, 8 living-donor nephrectomies, 1 laparoscopic kidney autotransplantation, 3 inguino-iliac/obturator lymph node dissections for melanoma, and 6 miscellanea procedures. Visualization of structures was provided by a high definition stereoscopic camera connected to a 30° 10 mm scope equipped with a specific lens and light source emitting both visible and near infra-red (NIR) light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). After injection of ICG, the system projected high-resolution NIR real-time images of blood flow in vessels and organs as well as highlighted biliary excretion .

No intraoperataive or injection-related adverse effects were reported, and the biliary/vascular anatomy was always clearly identified. The imaging system provided invaluable information to conduct a safe cholecystectomy and ensure adequate vascular supply for colectomy, nephrectomy, or find lymph nodes. There were no bile duct injuries or anastomotic leaks.

In our experience, the ICG fluorescence imaging system seems to be simple, safe, and useful. The technique may well become a standard in the near future in view of its different diagnostic and oncological capabilities. Larger studies and more specific evaluations are needed to confirm its role and to address its disadvantages.

• Adolescent
• Aged
• Aged, 80 and over
• Analysis of Variance
• Cholecystectomy, Laparoscopic/education
• Clinical Competence
• Databases, Factual
• Education, Medical, Graduate/methods
• Female
• Follow-Up Studies
• Hospitals, Teaching
• Humans
• Internship and Residency
• Learning Curve
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures/education
• Patient Safety
• Problem-Based Learning
• Prospective Studies
• Suture Techniques
• Time Factors
• Treatment Outcome
• Young Adult

• laparoscopic cholecystectomy
• bile duct injury
• fundus down cholecystectomy
• top down cholecystectomy
• antegrade cholecystectomy
• gallbladder

• Bile Ducts/injuries
• Bile Ducts/surgery
• Cholecystectomy, Laparoscopic/adverse effects
• Humans
• Iatrogenic Disease
• Intraoperative Complications/etiology
• Intraoperative Complications/prevention & control