Making Gallbladder Surgery Safer Via Minimally Invasive Surgery

Gallbladder removal is one of the most common surgeries performed in the United States. Each year, more than 750,000 people undergo a procedure called laparoscopic cholecystectomy, a minimally invasive surgery that uses small incisions and a camera to remove the gallbladder.

While this approach has many benefits — including less pain and faster recovery compared to traditional open surgery — it also carries a risk that many patients may not be aware of: injury to the bile duct. Although outcomes have improved significantly, this is still an important complication that surgeons must be aware of.

Domenech Asbun, M.D., a hepatobiliary and pancreatic surgeon at Baptist Health Miami Cancer Institute, is working to reduce that risk by promoting proven safety techniques.

“These surgeries are considered relatively simple, but you must approach each one with great care,” Dr. Asbun says. “When you have a bile duct injury, there can be very real and serious consequences to patients. There is a straightforward way to lessen the chance of a bile duct injury, and that is to follow the SAGES Safe Cholecystectomy teachings, which include the Critical View of Safety.”

What Is the “Critical View of Safety”?

The Critical View of Safety is a step-by-step method surgeons use during gallbladder surgery to clearly identify important structures before anything is cut.

During the procedure, the surgeon:

• Carefully clears tissue around the gallbladder duct and artery
• Separate the lower part of the gallbladder from the liver for better visibility
• Makes sure two and only two structures are connected to the gallbladder before proceeding

Many national and international guidelines suggest following these techniques, which were first promoted through the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Further recommendations include that surgeons consider a pause during the operation before cutting any ducts. This “surgical timeout” helps confirm that everything has been correctly identified, reducing the chance of injury.

Many of these safety measures were developed through a multi-society consensus conference, with physicians at Miami Cancer Institute helping to shape the recommendations.

Expanding Safer Surgery Around the World

Dr. Asbun is also focused on improving gallbladder surgery safety beyond the U.S. Through SAGES, he created the International Safe Cholecystectomy course designed to help surgeons in low- and middle-income countries, where access to advanced surgical training and healthcare resources can be limited.

About 90 percent of the world’s population lives in these countries, where complications after surgery can have even greater impact due to limited resources.

“This is critical information for countries in which limited resources and socioeconomic disparities have an exponential impact on complications after cholecystectomy. We work with a local champion surgeon in the area to determine how to make the course as useful to them and their particular circumstances as possible,” Dr. Asbun says.

The course has been held in two different countries, and four more courses are currently being organized across three continents. The safety techniques emphasized in this global course are equally important for surgeons in the U.S., helping ensure patients everywhere receive the safest care possible.

For more information about gallbladder surgery at Baptist Health Miami Cancer Institute, click here.