In 1989 a revolutionary change in surgery burst upon the scene of American medicine. Laparoscopic cholecystectomy was introduced, and literally within a matter of less than a year, virtually all surgeons were performing cholecystectomies using this method.

For more than a hundred years, open cholecystectomy had been the gold standard for the treatment of gallstones. Under this method of treatment the gallbladder, with the stones, was removed curing the condition. This surgery, while curative of the condition, carried with it a significant amount of pain and an extended period of recovery because of the fact that it had to be performed through a large incision in the patient's abdomen.

With the introduction of laparoscopic cholecystectomy, the need for the incision was eliminated, together with all of the inconvenience, pain, and a large scar. This change was truly desirable from the patient's point of view and a quantum leap forward in surgical technology.

Unfortunately, however, there were virtually no surgeons who possessed the requisite knowledge and skill to perform laparoscopic surgery safely without extensive training in the new procedure. There were many who started performing surgery without acquiring adequate training and skills. The result was that there was an explosion of injuries to patients' biliary systems as well as other parts of their bodies, and many patients were turned into biliary cripples requiring multiple operations and procedures in an effort to effect a repair - a result which was a medical disaster for the patient, who then became another victim of medical negligence.

After the initial flood of injuries, the injury rate from laparoscopic cholecystectomy appeared to decrease as more surgeons gained adequate training and experience. Unfortunately and for reasons that are not presently known, the rate of injury appears to be increasing again.

The most common injury has been termed the "classic injury" which results when the surgeon fails to identify the anatomy and cuts the patient's common bile duct, in most instances removing a portion of it. These cases are usually meritorious, as the injury is preventable if the surgery is properly performed. If it is not, and the wrong duct is cut, the results can be truly catastrophic and can even result in death.

 

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