Gallbladders – bread and butter cases or underestimated challenges? Join Dr. Patrick Georgoff and Dr. Shanaz Hossain as they sit down with Dr. Eric Knauer to discuss difficult gallbladders. In this episode, we discuss the SAGES Safe Cholecystectomy program that were created in an effort to decrease the incidence of bile duct injuries. The six strategies outlined in the program include:
1. Use the Critical View of Safety (CVS) method of identification of the cystic duct and cystic artery during laparoscopic cholecystectomy.

2. Understand the potential for aberrant anatomy in all cases.

3. Make liberal use of cholangiography or other methods to image the biliary tree intraoperatively.

4. Consider an Intra-operative Momentary Pause during laparoscopic cholecystectomy prior to clipping, cutting or transecting any ductal structures.

5. Recognize when the dissection is approaching a zone of significant risk and halt the dissection before entering the zone. Finish the operation by a safe method other than cholecystectomy if conditions around the gallbladder are too dangerous.

a. Subtotal Cholecystectomies – Learn more with this landmark paper: http://dx.doi.org/10.1016/j.jamcollsurg.2015.09.019

6. Get help from another surgeon when the dissection or conditions are difficult.

Take a look at all their great explanations and catch all the important points by completing the online program: https://www.sages.org/safe-cholecystectomy-program/

Dr. Eric Knauer is an assistant professor surgery at Emory University. He has recently published regarding the management of laparoscopic common bile duct stones in General Surgery News and, more importantly, was awarded the junior residents’ teaching award. Check out his great educational videos to learn more:
· Cholecystectomy: https://youtu.be/_oMNRINPY5I
Laparoscopic Common Bile Duct Exploration: https://youtu.be/mXl11I7mya0

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out other hepatobiliary episodes here: https://behindtheknife.org/podcast-category/hepatobiliary/

Difficult Gallbladders

Behind The Knife: The Surgery Podcast