• cholecystectomy
• cystic plate
• gallbladder
• iatrogenic biliary injury
• laparoscopy

• Aberrant hepatic duct
• Clinical anatomy
• Hepatic left duct
• Right hepatic duct
• Variations of the common hepatic duct

• Humans
• Anatomic Variation
• Hepatic Duct, Common/abnormalities
• Hepatic Duct, Common/anatomy & histology
• Cadaver
• Prevalence
• Liver/abnormalities
• Liver/anatomy & histology
• Liver/surgery
• Hepatectomy/methods

• bile duct injuries
• indocyanine green
• laparoscopic cholecystectomy
• learning curve
• operation time

• Humans
• Cholecystectomy, Laparoscopic/methods
• Cholecystectomy, Laparoscopic/education
• Indocyanine Green
• Learning Curve
• Retrospective Studies
• Male
• Female
• Middle Aged
• Adult
• Operative Time
• Internship and Residency
• Clinical Competence
• Coloring Agents
• Gallstones/surgery
• Gallstones/diagnostic imaging
• Aged

• anastomosis
• checklist
• colorectal surgery

• Humans
• Feasibility Studies
• Male
• Checklist
• Middle Aged
• Anastomosis, Surgical/methods
• Female
• Anastomotic Leak
• Prospective Studies
• Aged
• Colorectal Neoplasms/surgery
• Australia
• Colectomy/methods
• Colectomy/adverse effects

• Artificial intelligence (AI)
• Artificial intelligence and laparoscopic cholecystectomy (LC)
• Bile duct injury (BDI)
• Cholecystectomy
• Deep learning (DL)

• Humans
• Artificial Intelligence/trends
• Cholecystectomy, Laparoscopic/methods
• Cholecystectomy, Laparoscopic/trends
• Meta-Analysis as Topic
• Observational Studies as Topic
• Randomized Controlled Trials as Topic

• Università degli Studi di Napoli Federico II

• acute calculus cholecystitis
• bile duct injury
• indocyanine green
• laparoscopic cholecystectomy
• mirizzi syndrome
• near-infrared fluorescence cholangiography

• COVID-19
• Humans
• Ultrasonography/methods
• Curriculum
• Simulation Training/methods
• Germany
• Clinical Competence
• Education, Medical/trends
• Education, Medical/methods
• Computer Simulation

• Anatomical landmark detection
• Bile duct injury
• Convolutional neural network
• Deep learning
• Guided dissection line
• Laparoscopic cholecystectomy

• Acute calculous cholecystitis
• ICG
• NIFC
• Urgent laparoscopic cholecystectomy

• Humans
• Indocyanine Green
• Cholecystectomy, Laparoscopic
• Propensity Score
• Cholangiography/methods
• Coloring Agents

• Università degli Studi di Trieste

• Artificial intelligence
• Critical View of Safety
• Iatrogenic disease
• Image classification
• Laparoscopic cholecystectomy
• Surgical safety

• Humans
• Cholecystectomy, Laparoscopic/methods
• Artificial Intelligence
• Video Recording
• Surgeons
• Videotape Recording

• cholecystectomy
• critical view of safety
• diagonal line
• difficulty
• laparoscopic
• segment iv

• Laparoscopic cholecystectomy
• Operative reporting
• Patient safety
• Voice dictation

• Humans
• Cholecystectomy, Laparoscopic/adverse effects
• Dissection
• Arteries
• Liver
• Margins of Excision

• bile duct
• calots
• general surgery
• laparoscopic surgery
• rouviere sulcus

• Acute cholecystitis
• Difficult gallbladder
• Intraoperative cholangiography
• Laparoscopic subtotal cholecystectomy
• Percutaneous transhepatic gallbladder drainage
• Pericholecystic abscess

• gallbladder
• risk score
• subtotal cholecystectomy

Aberrant right posterior hepatic duct (ARPHD) is one of the anatomical anomalies of the bile duct. It is a risk factor for bile duct injury during laparoscopic cholecystectomy (LC). ARPHD can be diagnosed before surgery by magnetic resonance cholangiopancreatography or drip infusion cholangiographic-computed tomography. However, it is not easy to identify ARPHD during LC. Classic intraoperative cholangiography (IOC) procedure that does not lead to bile duct injury avoidance needs to be modified. In modified IOC, cannulation is performed from the infundibulum or neck of the gallbladder. We reported a modified and dynamic IOC procedure that can identify ARPHD safely and precisely during LC. The modified IOC provided direct evidence of no injury to ARPHD in 2 cases.

• bile duct injury
• cholangiography
• indocyanine green
• laparoscopic cholecystectomy
• near-infrared fluorescent cholangiography

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

• MRCP
• MRI
• acute cholecystitis
• cholecystectomy

We sought to determine if lateral–inferior traction on the Hartmann pouch could produce bile duct kinking and subsequent misinterpretation of the space on the left side of the bile duct as the hepatobiliary triangle. Once traction was applied, we measured the angle between the cystic duct and inferior gallbladder wall (hepatobiliary triangle) in 76 cases, and the angle between the common bile duct and common hepatic duct (porta hepatis “triangle”) in 41 cases. The mean angles were significantly different (hepatobiliary triangle mean 68.2°, standard deviation [SD] 16.0°, range 23–109°; porta hepatis “triangle” mean 112.0°, SD 18.4°, range 72–170°; p < 0.01). The ranges, however, overlapped in 26 cases. In many cases, lateral–inferior traction on the Hartmann pouch produced substantial kinking of the bile duct that could easily elicit the illusion that it is the hepatobiliary triangle rather than the centre of the porta hepatis.

• Biliary Tract Surgical Procedures
• Databases, Factual
• Hepatectomy/adverse effects
• Humans
• Pancreas
• Pancreatectomy/adverse effects

• additive manufacturing
• force sensor
• laparoscopic surgery
• motion tracking
• surgery simulator

• Clinical Competence
• Computer Simulation
• Feedback
• Humans
• Laparoscopy
• Mechanical Phenomena
• User-Computer Interface

Rouviere's sulcus is a 2–5 cm fissure on the liver between the right lobe and caudate process. The benefit of finding the Rouviere's sulcus during laparoscopic cholecystectomy is supported by the fact that the cystic duct and artery lay anterosuperior to the sulcus, and the common bile duct (CBD) lays below the level of the Rouviere's sulcus. Hence, it can serve as an extrabiliary anatomical reference point during laparoscopic cholecystectomy to identify the location of CBD.

This prospective observational study was carried out on 99 patients during a period of 1 year. During laparoscopic cholecystectomy, Rouviere's sulcus was identified after retracting the fundus of the gallbladder toward the right shoulder. Its morphology in terms of open type, close type, or scar-like shapes was recorded, and if the CBD outline could be visualized, then its relation with the Rouviere's sulcus was noted.

Among all 99 study patients, Rouviere's sulcus could be identified in 63 cases (63.63%), whereas it could not be seen in 36 cases (36.36%) (P < 0.007). It was of open type in 68.25% (43 cases), close type in 25.39% (16 cases), and scar like in 6.35% (4 cases) (P < 0.0001). The Rouviere's sulcus was found to be above the level of CBD line in 50 patients (79.36%) and at the same level in 11 patients (17.46%), and in two patients, (5.97%) CBD line could not be visualized.

Identification of Rouviere's sulcus during laparoscopic cholecystectomy can serve as an additional reference point to avoid major bile duct injury. In the era of laparoscopy, it can be better visualized after creating the pneumoperitoneum and retracting the fundus of the gallbladder.

• Bile duct
• cholecystectomy
• extrabiliary
• laparoscopy

The high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery.

The aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality).

In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability.

Evidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures.

The results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery.

• Leap Motion Controller
• computer-assisted surgery
• medical education
• minimally invasive surgical procedures
• simulation training
• user-computer interface

• Aberrant biliary duct
• Bile duct injury
• Biliary tree
• Cholelithiasis
• Endoscopic retrograde cholangiopancreatography
• Gallbladder
• Intraoperative complications
• Laparoscopic cholecystectomy
• Segment 5

• Anatomy
• Bile duct injury
• Caudate process
• Liver

Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury.

A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-o’clock position as cranial, 6-o’clock as dorsal, 9-o’clock as caudal, and 12-o’clock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images.

All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-o’clock position, 6-o’clock position, 9-o’clock position, 12-o’clock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-o’clock and 12-o’clock position were pitfalls that might cause biliary injury.

The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.

• Rouvière's sulcus
• bile duct injury
• laparoscopic cholecystectomy

• Artificial intelligence
• Bile duct injury
• Deep learning
• Landmark
• Laparoscopic cholecystectomy

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bile Duct Diseases/diagnosis
• Bile Duct Diseases/epidemiology
• Bile Duct Diseases/surgery
• Bile Ducts/injuries
• Cholecystectomy, Laparoscopic/adverse effects
• Developing Countries
• Female
• Humans
• Male
• Middle Aged
• Referral and Consultation
• Retrospective Studies
• South Africa
• Young Adult

• Bile duct
• Cystic duct
• Portal vein
• Variant
• Variation

• Biliary anatomy
• Hepatic ducts
• Hepatobiliary surgery
• Liver anatomy

• bile duct injury
• biliary anatomy
• early recognition
• endoscopic treatment
• laparoscopic cholecystectomy
• management challenge
• surgical repair

• Bile duct injury
• Bile leak
• Cholecystectomy
• Cholecystitis
• Cholelithiasis

• Bile duct injury
• Bile leak
• Cholecystectomy
• Cholecystitis
• Cholelithiasis

• anatomic landmarks
• choledochostomy
• cholelithiasis
• laparoscopic surgery

• Anatomic Landmarks/diagnostic imaging
• China
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Choledocholithiasis/surgery
• Common Bile Duct/diagnostic imaging
• Common Bile Duct/injuries
• Common Bile Duct/pathology
• Female
• Humans
• Imaging, Three-Dimensional/methods
• Intraoperative Complications/prevention & control
• Length of Stay
• Male
• Middle Aged
• Operative Time
• Risk Adjustment/methods
• Treatment Outcome

• Bile duct injury
• Critical view of safety
• Delphi consensus
• Laparoscopic cholecystectomy
• Surgical difficulty