Lecture : The HBP surgeons perform a variable kinds of operations from simple cholecystectomies to major operations. All surgeries are always stressful to the surgeon, but they can be more stressful if complications or iatrogenic problems arise during simple cholecystectomy for benign disease. This complication can sometimes result in severe morbidity and mortality. We usually perform several hundreds or several thousands cases of the laparoscopic cholecystectomy throughout our whole life. So I think that cholecystectomy is the most important operation for HBP surgeons.
When I was resident, my master said to me " I've never seen the same shape of gallbladder during my whole surgeon's life." At that time I couldn't understand his lesson, but now I totally understand him not until I have done several thousands of gallbladder operations. There are so many variants of structure due to anatomical variation, severity of inflammation or extent of fibrosis in Calot's triangle.
The iatrogenic complications may occur more and more during the learning period. Of course the surgeon's experience and technical skill can be emphasized in this period. As soon as we become experienced, the complication rate declined rapidly downward But I become aware that my complication rate of laparoscopic cholecystectomy did not decline according to the increase of my individual volume and experiences of cases. We know that major causes of complications including BDI or vascular injury are related to technique related to surgeon's experience, pathology and anatomical anomalies of bile duct & arterial variations. There was 68,926 cases of cholecystectomy in Korea, 2017. If we suspect the incidence of BDI complication was 0.5%, we can assume that 346 cases of BDI occurred. This is non-negligible number.
I think that the most important factor of BDI may be not pathology and anatomical anomalies of gallbladder but surgeon's carelessness or arrogance. So I think surgeon's mental attitude that devote to "Back to the basic" will be most important for prevention of BDI. I’d like to present the keypoints and my experiences to prevent the BDI complications briefly for young HBP surgeon.