Abstract
Background: Creating a “safety zone” during laparoscopic cholecystectomy is defined as dissection of the cystic duct as close as possible to the gallbladder.
Methods: In 29 out of 802 cases in which laparoscopic cholecystectomy was difficult to perform due to uncertainty about the orientation of Calot's triangle, intraoperative cholangiography was performed, using a titanium clip as a marker that designated the safety zone. The distance between the clip and the common hepatic duct or the common bile duct could be determined by evaluation of two intraoperative cholangiograms taken in different orientation.
Results: If the clip was located in the safety zone, and was distant from the common hepatic duct or common bile duct, the safety of preparation around the clip was ensured. No complication was encountered in these cases with this method. Eventually, no biliary tract injury was experienced, and the overall conversion rate to open cholecystectomy was only 0.4% (3 of 802 consecutive cases).
Conclusions: This method of confirming the safety zone by intraoperative cholangiography is a useful procedure for avoiding inadvertent injury to the biliary tract.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cuschieri A, Dubos F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161: 385–387
Deziel DJ, Millakan KW, Economou SG, Doolas A, Ko ST, Airan M (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165: 9–14
Ido K, Kimura K, Kawamoto C, Satoh S, Isoda N, Taniguchi Y, Suzuki T, Ohtani M, Kumagai M, Horikawa S (1992) Preliminary experience using laparoscopic transcystic cholangioscopy for treatment of common bile duct stones. Endoscopy 24: 749–752
Kimura K, Ido K, Taniguchi Y, Kawamoto C, Satoh S, Isoda N, Ohtani M, Kumagai M, Horikawa S (1992) Prospective study of laparoscopic cholecystectomy in two hundred and fifty patients. Endoscopy 24: 739–743
Kimura T, Kimura K, Suzuki K, Sakai S, Ohtomo Y, Sakuramachi S, Yamashita Y, Ido K, Kitano S, Yazaki Y (1993) Laparoscopic cholecystectomy: the Japanese experience. Surg Laparosc Endosc 3: 194–198
Larson GM, Vitale GC, Casey J, Evans JS, Gillian G, Heuser L, Mcgee G, Rao M, Scherm MJ, Voyles CR (1992) Multipractice analysis of laparoscopic cholecystectomy in 1,938 patients. Am J Surg 163: 221–226
Orlando R, Russel JC, Lynch J (1993) Laparoscopic cholecystectomy: a statewide experience. Arch Surg 128: 494–499
Taniguchi Y, Ido K, Kimura K, Yoshida Y, Ohtani M, Kawamoto C, Isoda N, Suzuki T, Kumagai M (1993) Introduction of a “safety zone” for the safety of laparoscopic cholecystectomy. Am J Gastroenterol 88: 1258–1261
The Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078
Williams LF Jr, Chapman WC, Bonau RA, Macgee EC Jr, Boyed RW, Jacob JK (1993) Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center. Am J Surg 165: 459–465
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ido, K., Isoda, N., Kawamoto, C. et al. Confirmation of a “safety zone” by intraoperative cholangiography during laparoscopic cholecystectomy. Surg Endosc 10, 798–800 (1996). https://doi.org/10.1007/BF00189536
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00189536