Rules of Thumb to Help Prevent Bile Duct Injuries

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Optimize Imaging:
    • Use high-quality imaging equipment
  • Initial Steps and Objectives:
    • Before starting the dissection:
      • Use the triangle of Calot for orientation
    • Find the cystic duct starting at the triangle of Calot
    • Pull the gallbladder infundibulum laterally to open the triangle of Calot
    • Clear the medial wall of the gallbladder infundibulum
    • Make sure the cystic duct can be traced uninterrupted into the base of the gallbladder
    • Open any subtle tissue plane between the gallbladder and the presumed cystic duct:
      • The real cystic duct may be hidden in there
  • Factors that Suggest One may be dissecting the Common Duct instead of the Cystic Duct :
    • The duct when clipped is not fully encompassed by a standard M/L clip (9 mm)
    • Any duct that can be traced without interruption to course behind the duodenum is probably the common bile duct
    • Another unexpected ductal structure is present
    • A large artery is behind the duct:
      • The right hepatic artery runs posterior to the common bile duct
    • Extralymphatic and vascular structures are encountered in the dissection
    • The proximal hepatic ducts fail to opacify on operative cholangiograms

#Arrangoiz #Surgeon #Teacher

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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