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Case Reports
. 2010 Apr-Jun;14(2):268-71.
doi: 10.4293/108680810X12785289144593.

Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy

Amareshwar Chiruvella  1 , Juan M Sarmiento, John F Sweeney, Edward Lin, Steven Scott Davis Jr
Affiliations
Case Reports

Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy

Amareshwar Chiruvella et al. JSLS. 2010 Apr-Jun.

Abstract

Background: Numerous recent reports describe the performance of laparoscopic procedures through a single incision. Although the feasibility of this approach for a variety of procedures is currently being established, little data are available regarding safety.

Case report: A 65-year-old female patient who was transferred from an outside institution had undergone a single incision laparoscopic cholecystectomy that resulted in biliary tract and vascular injuries.

Methods: The patient was transferred with a known bile duct injury on the first postoperative day following single incision laparoscopic cholecystectomy. Review of her magnetic resonance imaging and percutaneous transhepatic cholangiogram studies showed a Bismuth type 3 bile duct injury. Hepatic angiogram demonstrated an occlusion of the right hepatic artery with collateralization from the left hepatic artery. She was initially managed conservatively with a right-sided external biliary drain, followed 6 weeks later by a Hepp-Couinaud procedure to reconstruct the biliary tract.

Conclusion: As new techniques evolve, it is imperative that safety, or potential side effects, or both safety and side effects, be monitored, because no learning curve is established for these new techniques. In these initial stages, surgeons should have a low threshold to add additional ports when necessary to ensure that procedures are completed safely.

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Figures

Figure 1.
Figure 1.
Magnetic resonance cholangiopancreatography showing Bismuth Type III injury. Arrow points to the nonvisualization of the common bile duct. CBD=Common Bile Duct.
Figure 2.
Figure 2.
Percutaneous transhepatic cholangiogram showing Bismuth Type III injury. RHD=Right Hepatic Duct, LHD=Left Hepatic Duct.
Figure 3.
Figure 3.
Angiogram showing right hepatic artery injury. Note the presence of a left hepatic artery that bifurcates into lateral and medial branches with the latter creating an anastomosis to supply the right lobe. Note the stump of the original right hepatic artery. Clips in the place corresponding to the take-off of the right hepatic artery.
Figure 4.
Figure 4.
Postoperative percutaneous transhepatic cholangiogram showing patency of the new bilioenteric anastomosis.
See this image and copyright information in PMC

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