Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework?

Yukio Iwashita; Taizo Hibi; Tetsuji Ohyama; Akiko Umezawa; Tadahiro Takada; Steven M Strasberg; Horacio J Asbun; Henry A Pitt; Ho-Seong Han; Tsann-Long Hwang; Kenji Suzuki; Yoo-Seok Yoon; In-Seok Choi; Dong-Sup Yoon; Wayne Shih-Wei Huang; Masahiro Yoshida; Go Wakabayashi; Fumihiko Miura; Kohji Okamoto; Itaru Endo; Eduardo de Santibanes; Mariano Eduardo Giménez; John A Windsor; James Garden; Dirk J Gouma; Daniel Cherqui; Giulio Belli; Christos Dervenis; Daniel J Deziel; Eduard C Jonas; Palepu Jagannath; Avinash Nivritti Supe; Harjit Singh; Kui-Hin Liau; Xiao-Ping Chen; Angus C W Chan; Wan Yee Lau; Sheung Tat Fan; Miin-Fu Chen; Myung-Hwan Kim; Goro Honda; Atsushi Sugioka; Koji Asai; Keita Wada; Yasuhisa Mori; Ryota Higuchi; Takeshi Misawa; Manabu Watanabe; Naoki Matsumura; Toshiki Rikiyama; Naohiro Sata; Nobuyasu Kano; Hiromi Tokumura; Taizo Kimura; Seigo Kitano; Masafumi Inomata; Koichi Hirata; Yoshinobu Sumiyama; Kazuo Inui; Masakazu Yamamoto

doi:10.1002/jhbp.503

Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework?

Yukio Iwashita, Taizo Hibi, Tetsuji Ohyama, Akiko Umezawa, Tadahiro Takada, Steven M Strasberg, Horacio J Asbun, Henry A Pitt, Ho-Seong Han, Tsann-Long Hwang, Kenji Suzuki, Yoo-Seok Yoon, In-Seok Choi, Dong-Sup Yoon, Wayne Shih-Wei Huang, Masahiro Yoshida, Go Wakabayashi, Fumihiko Miura, Kohji Okamoto, Itaru EndoEduardo de Santibanes, Mariano Eduardo Giménez, John A Windsor, James Garden, Dirk J Gouma, Daniel Cherqui, Giulio Belli, Christos Dervenis, Daniel J Deziel, Eduard C Jonas, Palepu Jagannath, Avinash Nivritti Supe, Harjit Singh, Kui-Hin Liau, Xiao-Ping Chen, Angus C W Chan, Wan Yee Lau, Sheung Tat Fan, Miin-Fu Chen, Myung-Hwan Kim, Goro Honda, Atsushi Sugioka, Koji Asai, Keita Wada, Yasuhisa Mori, Ryota Higuchi, Takeshi Misawa, Manabu Watanabe, Naoki Matsumura, Toshiki Rikiyama, Naohiro Sata, Nobuyasu Kano, Hiromi Tokumura, Taizo Kimura, Seigo Kitano, Masafumi Inomata, Koichi Hirata, Yoshinobu Sumiyama, Kazuo Inui, Masakazu Yamamoto

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce.

METHODS: Surgeons from Japan, Korea, Taiwan, and the U.S., etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5.

RESULTS: Response rates for the first- and the second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: 1) Effective retraction of the gallbladder, 2) Always obtaining critical view of safety, and 3) Avoiding excessive use of electrocautery/clipping as vital procedures; and 4) Calot's triangle area and 5) Critical view of safety as important landmarks. For 6) Impacted gallstone and 7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated.

CONCLUSIONS: A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI. This article is protected by copyright. All rights reserved.

Original language	English
Journal	Journal of Hepato-Biliary-Pancreatic Sciences
Volume	24
Issue number	11
Early online date	8 Sept 2017
DOIs	https://doi.org/10.1002/jhbp.503
Publication status	Published - Nov 2017

Keywords / Materials (for Non-textual outputs)

Journal Article

Access to Document

10.1002/jhbp.503

Iwashita_et_al-2017-Journal_of_Hepato-Biliary-Pancreatic_SciencesAccepted author manuscript, 734 KB

Cite this

Iwashita, Y., Hibi, T., Ohyama, T., Umezawa, A., Takada, T., Strasberg, S. M., Asbun, H. J., Pitt, H. A., Han, H-S., Hwang, T-L., Suzuki, K., Yoon, Y-S., Choi, I-S., Yoon, D-S., Huang, W. S-W., Yoshida, M., Wakabayashi, G., Miura, F., Okamoto, K., ... Yamamoto, M. (2017). Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework? Journal of Hepato-Biliary-Pancreatic Sciences, 24(11). Advance online publication. https://doi.org/10.1002/jhbp.503

@article{94e0f2c0a17f42a3a68dd8469276c5a9,

title = "Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework?",

abstract = "BACKGROUND: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce.METHODS: Surgeons from Japan, Korea, Taiwan, and the U.S., etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5.RESULTS: Response rates for the first- and the second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: 1) Effective retraction of the gallbladder, 2) Always obtaining critical view of safety, and 3) Avoiding excessive use of electrocautery/clipping as vital procedures; and 4) Calot's triangle area and 5) Critical view of safety as important landmarks. For 6) Impacted gallstone and 7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated.CONCLUSIONS: A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI. This article is protected by copyright. All rights reserved.",

keywords = "Journal Article",

author = "Yukio Iwashita and Taizo Hibi and Tetsuji Ohyama and Akiko Umezawa and Tadahiro Takada and Strasberg, {Steven M} and Asbun, {Horacio J} and Pitt, {Henry A} and Ho-Seong Han and Tsann-Long Hwang and Kenji Suzuki and Yoo-Seok Yoon and In-Seok Choi and Dong-Sup Yoon and Huang, {Wayne Shih-Wei} and Masahiro Yoshida and Go Wakabayashi and Fumihiko Miura and Kohji Okamoto and Itaru Endo and {de Santibanes}, Eduardo and Gim{\'e}nez, {Mariano Eduardo} and Windsor, {John A} and James Garden and Gouma, {Dirk J} and Daniel Cherqui and Giulio Belli and Christos Dervenis and Deziel, {Daniel J} and Jonas, {Eduard C} and Palepu Jagannath and Supe, {Avinash Nivritti} and Harjit Singh and Kui-Hin Liau and Xiao-Ping Chen and Chan, {Angus C W} and Lau, {Wan Yee} and Fan, {Sheung Tat} and Miin-Fu Chen and Myung-Hwan Kim and Goro Honda and Atsushi Sugioka and Koji Asai and Keita Wada and Yasuhisa Mori and Ryota Higuchi and Takeshi Misawa and Manabu Watanabe and Naoki Matsumura and Toshiki Rikiyama and Naohiro Sata and Nobuyasu Kano and Hiromi Tokumura and Taizo Kimura and Seigo Kitano and Masafumi Inomata and Koichi Hirata and Yoshinobu Sumiyama and Kazuo Inui and Masakazu Yamamoto",

year = "2017",

month = nov,

doi = "10.1002/jhbp.503",

language = "English",

volume = "24",

journal = "Journal of Hepato-Biliary-Pancreatic Sciences",

issn = "1868-6974",

publisher = "Springer Verlag",

number = "11",

}

Iwashita, Y, Hibi, T, Ohyama, T, Umezawa, A, Takada, T, Strasberg, SM, Asbun, HJ, Pitt, HA, Han, H-S, Hwang, T-L, Suzuki, K, Yoon, Y-S, Choi, I-S, Yoon, D-S, Huang, WS-W, Yoshida, M, Wakabayashi, G, Miura, F, Okamoto, K, Endo, I, de Santibanes, E, Giménez, ME, Windsor, JA, Garden, J, Gouma, DJ, Cherqui, D, Belli, G, Dervenis, C, Deziel, DJ, Jonas, EC, Jagannath, P, Supe, AN, Singh, H, Liau, K-H, Chen, X-P, Chan, ACW, Lau, WY, Fan, ST, Chen, M-F, Kim, M-H, Honda, G, Sugioka, A, Asai, K, Wada, K, Mori, Y, Higuchi, R, Misawa, T, Watanabe, M, Matsumura, N, Rikiyama, T, Sata, N, Kano, N, Tokumura, H, Kimura, T, Kitano, S, Inomata, M, Hirata, K, Sumiyama, Y, Inui, K & Yamamoto, M 2017, 'Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework?', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 24, no. 11. https://doi.org/10.1002/jhbp.503

TY - JOUR

T1 - Delphi consensus on bile duct injuries during laparoscopic cholecystectomy

T2 - An evolutionary cul-de-sac or the birth pangs of a new technical framework?

AU - Iwashita, Yukio

AU - Hibi, Taizo

AU - Ohyama, Tetsuji

AU - Umezawa, Akiko

AU - Takada, Tadahiro

AU - Strasberg, Steven M

AU - Asbun, Horacio J

AU - Pitt, Henry A

AU - Han, Ho-Seong

AU - Hwang, Tsann-Long

AU - Suzuki, Kenji

AU - Yoon, Yoo-Seok

AU - Choi, In-Seok

AU - Yoon, Dong-Sup

AU - Huang, Wayne Shih-Wei

AU - Yoshida, Masahiro

AU - Wakabayashi, Go

AU - Miura, Fumihiko

AU - Okamoto, Kohji

AU - Endo, Itaru

AU - de Santibanes, Eduardo

AU - Giménez, Mariano Eduardo

AU - Windsor, John A

AU - Garden, James

AU - Gouma, Dirk J

AU - Cherqui, Daniel

AU - Belli, Giulio

AU - Dervenis, Christos

AU - Deziel, Daniel J

AU - Jonas, Eduard C

AU - Jagannath, Palepu

AU - Supe, Avinash Nivritti

AU - Singh, Harjit

AU - Liau, Kui-Hin

AU - Chen, Xiao-Ping

AU - Chan, Angus C W

AU - Lau, Wan Yee

AU - Fan, Sheung Tat

AU - Chen, Miin-Fu

AU - Kim, Myung-Hwan

AU - Honda, Goro

AU - Sugioka, Atsushi

AU - Asai, Koji

AU - Wada, Keita

AU - Mori, Yasuhisa

AU - Higuchi, Ryota

AU - Misawa, Takeshi

AU - Watanabe, Manabu

AU - Matsumura, Naoki

AU - Rikiyama, Toshiki

AU - Sata, Naohiro

AU - Kano, Nobuyasu

AU - Tokumura, Hiromi

AU - Kimura, Taizo

AU - Kitano, Seigo

AU - Inomata, Masafumi

AU - Hirata, Koichi

AU - Sumiyama, Yoshinobu

AU - Inui, Kazuo

AU - Yamamoto, Masakazu

PY - 2017/11

Y1 - 2017/11

N2 - BACKGROUND: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce.METHODS: Surgeons from Japan, Korea, Taiwan, and the U.S., etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5.RESULTS: Response rates for the first- and the second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: 1) Effective retraction of the gallbladder, 2) Always obtaining critical view of safety, and 3) Avoiding excessive use of electrocautery/clipping as vital procedures; and 4) Calot's triangle area and 5) Critical view of safety as important landmarks. For 6) Impacted gallstone and 7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated.CONCLUSIONS: A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce.METHODS: Surgeons from Japan, Korea, Taiwan, and the U.S., etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5.RESULTS: Response rates for the first- and the second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: 1) Effective retraction of the gallbladder, 2) Always obtaining critical view of safety, and 3) Avoiding excessive use of electrocautery/clipping as vital procedures; and 4) Calot's triangle area and 5) Critical view of safety as important landmarks. For 6) Impacted gallstone and 7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated.CONCLUSIONS: A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI. This article is protected by copyright. All rights reserved.

KW - Journal Article

U2 - 10.1002/jhbp.503

DO - 10.1002/jhbp.503

M3 - Article

C2 - 28884962

SN - 1868-6974

VL - 24

JO - Journal of Hepato-Biliary-Pancreatic Sciences

JF - Journal of Hepato-Biliary-Pancreatic Sciences

IS - 11

ER -

Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: An evolutionary cul-de-sac or the birth pangs of a new technical framework?

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

Access to Document

Fingerprint

Cite this