Commentary: Perceptual Errors Leading to Bile Duct Injury During Laparoscopic Cholecystectomy

Despite nearly three decades since the introduction of laparoscopic cholecystectomy, bile duct injury (BDI) continues to be its “Achilles Heel.” The unique characteristics of laparoscopic surgery, particularly the visual-spatial peculiarities, lead to neurocognitive perceptual errors that likely contribute to the creation of a BDI. Surgeons must be aware of these potential perceptual errors and develop strategies to mitigate the occurrence of biliary injury. One such strategy is to dissect the operative field until establishing the critical view of safety before clipping or cutting any tubular structures. Several operative tactics are described that may assist the surgeon in achieving the critical view. Framing errors are common in which surgeons subconsciously recreate what appears to be normal anatomy despite cues to the contrary—asking another surgeon to view the operative field is a very useful means to help overcome these particular errors. All efforts should be made to minimize the occurrence of BDI, a potential devastating complication.