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2026, Number 2

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Cir Gen 2026; 48 (2)

Zero Disruption Policies 2026 of the Mexican Association of General Surgery (PDC2026): A best practice guideline for cholecystectomy without biliovascular disruption

Loera-Torres MA, Ordóñez-Gutiérrez ME, Beristain-Hernández JL, Moreno-Paquentín E, Chapa-Azuela O, Ortiz-Higareda V, Noyola-Villalobos H, Martínez-Abundis R, Sánchez-Reyes K, López-Gavito E, Velázquez-Fernández D

Language: Spanish
References: 95
Page: 112-133
PDF size: 1017.43 Kb.


ABSTRACT

Zero Disruption Policy 2026 (PDC2026) of the Mexican Association of General Surgery, proposes a best-practice guideline aimed at minimizing biliovascular disruption during cholecystectomy. Bile duct disruption is one of the most severe complications in abdominal surgery, with significant clinical, economic, emotional, and medical-legal implications. Its occurrence is not attributable solely to technical inexperience, but also to errors in visual perception and cognitive processing, particularly in scenarios involving inflammation, fibrosis, hostile anatomy, fatigue, or intraoperative stress. PDC2026 integrates 10 axiomatic principles and 22 perioperative directives, designed to transform cholecystectomy into a systematic, reproducible, teachable, auditable, and interoperable process. It is grounded in the existing evidence from the international literature and in guidelines issued by the world's leading surgical organizations. Its central technical axis is the achievement of the Critical View of Safety (CVS) and the adoption of bailout procedures when it cannot be safely obtained. The model emphasizes preoperative planning, informed consent, risk stratification using the Nassar score, universal adoption of intraoperative grading with the Parkland classification, mandatory use of B-SAFE orientation and the R4U line, strategic surgical pauses, verbal declaration of critical findings, safe use of energy devices, selective intraoperative imaging, and the complementary incorporation of emerging technologies for verification, training, and audit. It also recognizes the physical and mental well-being of the surgical team as an active component of patient safety. Finally, it proposes the Minimum Interoperable Structured Record (MISR) to document the essential variables of the surgical procedure and facilitate continuity of care, audit, and research. In summary, the PDC2026 constitutes a comprehensive surgical safety system whose objective is to prevent improvisation and prioritize the patient's life over the forced resolution of the surgical problem.


REFERENCES

  1. de'Angelis N, Catena F, Memeo R, Coccolini F, Martino A, de Simone B, et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg. 2021; 16: 30. doi: 10.1186/s13017-021-00369-w.

  2. Tornqvist B, Stromberg C, Persson G, Nilsson M. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ. 2012; 345: e6457. doi: 10.1136/bmj.e6457.

  3. Tornqvist B, Stromberg C, Akre O, Enochsson L, Nilsson M. Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy. Br J Surg. 2015; 102: 952-958. doi:10.1002/bjs.9832.

  4. Gross A, Said SA, Wehrle CJ, Hong H, Quick J, Larson S, et al. Selective vs routine cholangiography across a health care enterprise. JAMA Surg. 2025; 160: 145-152. doi: 10.1001/jamasurg.2024.5216.

  5. Mangieri CW, Hendren BP, Strode MA, Bandera BC, Faler BJ. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc. 2019; 33: 724-730. doi: 10.1007/s00464-018-6333-7.

  6. Al-Ghunaim TA, Johnson J, Biyani CS, Alshahrani KM, Dunning A, O'Connor DB. Surgeon burnout, impact on patient safety and professionalism: a systematic review and meta-analysis. Am J Surg. 2022; 224: 228-238. doi: 10.1016/j.amjsurg.2021.12.027.

  7. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017; 177: 1826-1832. doi: 10.1001/jamainternmed.2017.4340.

  8. Reijmerink IM, van der Laan MJ, Wietasch JKG, Hooft L, Cnossen F. Impact of fatigue in surgeons on performance and patient outcome: systematic review. Br J Surg. 2024; 111: znad397. doi: 10.1093/bjs/znad397.

  9. Quan SF, Landrigan CP, Barger LK, Buie JD, Dominguez C, Iyer JM, et al. Impact of sleep deficiency on surgical performance: a prospective assessment. J Clin Sleep Med. 2023; 19: 673-683. doi: 10.5664/jcsm.10406.

  10. Trockel MT, Menon NK, Rowe SG, Stewart MT, Smith R, Lu M, et al. Assessment of physician sleep and wellness, burnout, and clinically significant medical errors. JAMA Netw Open. 2020; 3: e2028111. doi: 10.1001/jamanetworkopen.2020.28111.

  11. Janhofer DE, Lakhiani C, Song DH. Addressing surgeon fatigue: current understanding and strategies for mitigation. Plast Reconstr Surg. 2019; 144: 693e-699e. doi: 10.1097/PRS.0000000000006060.

  12. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 730 summary: fatigue and patient safety. Obstet Gynecol. 2018; 131: 412-413.

  13. Noyola VHF, Ortiz HV, Chapa AO, Martínez MG, Martínez AR, Rodríguez MCA, et al. Programa de Recuperación Quirúrgica Mejorada. Colecistectomía Segura. Cir Gen. 2024; 46: 11-25. doi: 10.35366/117364.

  14. Sarmiento-Altamirano D, Ormaza F, Arroyo MR, Tandazo-Villao K, Gómez-Rosero R, Zalamea-Molina V, et al. Optimizing laparoscopic and robotic skills through simulation in participants with limited or no prior experience: a systematic review and meta-analysis. J Gastrointest Surg. 2024; 28: 566-576. doi: 10.1016/j.gassur.2024.01.027.

  15. Thomaschewski M, Vonthein R, Keck T, Laubert T, Benecke C; NOVICE study group. Laparoscopic simulation training improves operating room performance of surgical residents: a multicenter randomized trial (NOVICE). Int J Surg. 2025; 111: 2923-2932. doi: 10.1097/JS9.0000000000002304.

  16. Kowalewski KF, Garrow CR, Proctor T, Preukschas AA, Scheidt F, Kenngott HG, et al. LapTrain: multi-modality training curriculum for laparoscopic cholecystectomy—results of a randomized controlled trial. Surg Endosc. 2018; 32: 3830-3838. doi: 10.1007/s00464-018-6086-3.

  17. Kojima Y, Wong HJ, Kuchta K, Linn JG, Denham W, Haggerty SP, et al. Subjective vs. objective assessment of simulation performance on laparoscopic cholecystectomy: are we evaluating the right things? Surg Endosc. 2022; 36: 6661-6671. doi: 10.1007/s00464-022-09021-3.

  18. Dawe SR, Windsor JA, Broeders JA, Cregan PC, Hewett PJ, Maddern GJ. A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg. 2014; 259: 236-248. doi: 10.1097/SLA.0000000000000268.

  19. Zendejas B, Brydges R, Hamstra SJ, Cook DA. State of the evidence on simulation-based training for laparoscopic surgery: a systematic review. Ann Surg. 2013; 257: 586-593. doi: 10.1097/SLA.0b013e31828944f0.

  20. Huffman EM, Choi JN, Martin JR, Mielke N, Lak K, Lyu H, et al. A competency-based laparoscopic cholecystectomy curriculum significantly improves general surgery residents' operative performance and decreases skill variability: cohort study. Ann Surg. 2022; 276: e1083-e1088. doi: 10.1097/SLA.0000000000004752.

  21. Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg. 2007; 246: 771-779. doi: 10.1097/SLA.0b013e3180f61b09.

  22. Wu S, Tang M, Liu J, Qin D, Wang Y, Zhai S, et al. Impact of an AI-based laparoscopic cholecystectomy coaching program on the surgical performance: a randomized controlled trial. Int J Surg. 2024; 110: 7816-7823. doi: 10.1097/JS9.0000000000001798.

  23. Khalid MU, Laplante S, Masino C, Anugu V, Madani A, Fried GM, et al. Use of artificial intelligence for decision-support to avoid high-risk behaviors during laparoscopic cholecystectomy. Surg Endosc. 2023; 37: 9467-9475. doi: 10.1007/s00464-023-10362-8.

  24. Fried GM, Ortenzi M, Dayan D, Nizri E, Mirkin Y, Maril S, et al. Surgical intelligence can lead to higher adoption of best practices in minimally invasive surgery. Ann Surg. 2024; 280: 525-534. doi: 10.1097/SLA.0000000000006377.

  25. Tariq S, Cainelli F, Sahraoui AZ, Achar A. Extended reality in laparoscopic cholecystectomy training: a systematic review and meta-analysis. J Surg Res. 2025; 316: 143-150. doi: 10.1016/j.jss.2025.02.014.

  26. Wild C, Lang F, Gerhauser AS, Gartner F, Wurnig M, Kunz WG, et al. Telestration with augmented reality for visual presentation of intraoperative target structures in minimally invasive surgery: a randomized controlled study. Surg Endosc. 2022; 36: 7453-7461. doi: 10.1007/s00464-022-09163-4.

  27. Huettl F, Heinrich F, Boedecker C, Saalfeld S, Huber T, Lang H, et al. Real-time augmented reality annotation for surgical education during laparoscopic surgery: results from a single-center randomized controlled trial and future aspects. J Am Coll Surg. 2023; 237: 292-300. doi: 10.1097/XCS.0000000000000768.

  28. Diana M, Soler L, Agnus V, Nicolau S, Piccoli M, Swanstrom L, et al. Prospective evaluation of precision multimodal gallbladder surgery navigation: virtual reality, near-infrared fluorescence, and X-ray-based intraoperative cholangiography. Ann Surg. 2017; 266: 890-897. doi: 10.1097/SLA.0000000000002127.

  29. Nagendran M, Gurusamy KS, Aggarwal R, Loizidou M, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2013; 8: CD006575. doi: 10.1002/14651858.CD006575.pub3.

  30. Committee on Ethics. Informed consent and shared decision making in obstetrics and gynecology: ACOG Committee Opinion, Number 819. Obstet Gynecol. 2021; 137: e34-e41.

  31. Deer T, Patel AA, Sayed D, Grider JS, Pope JE, Hunter CW, et al. Informed consent for spine procedures: best practice guideline from the American Society of Pain and Neuroscience (ASPN). J Pain Res. 2023; 16: 3559-3568. doi: 10.2147/JPR.S418043.

  32. Kinnersley P, Phillips K, Savage K, Kelly MJ, Farrell E, Morgan B, et al. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Database Syst Rev. 2013; 7: CD009445. doi: 10.1002/14651858.CD009445.pub2.

  33. Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg. 2005; 241: 786-795. doi: 10.1097/01.sla.0000161029.27410.71.

  34. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Pedrosa MC, Fernandez-del Castillo C, et al. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg. 2018; 226: 568-576.e1. doi: 10.1016/j.jamcollsurg.2018.01.004.

  35. Aaron E, Amabile A, Andolfi C, et al. Gastrointestinal Surgical Emergencies Textbook. Chicago: American College of Surgeons; 2021.

  36. Fairchild AH, Hohenwalter EJ, Gipson MG, Gomes AS, Kapoor BS, Knavel-Koepsel EM, et al. ACR appropriateness criteria radiologic management of biliary obstruction. J Am Coll Radiol. 2019; 16: S196-S213. doi: 10.1016/j.jacr.2019.02.038.

  37. Wang X, Yu WL, Fu XH, Sun LS, Lu Q, Wang Q, et al. Early versus delayed surgical repair and referral for patients with bile duct injury: a systematic review and meta-analysis. Ann Surg. 2020; 271: 449-459. doi: 10.1097/SLA.0000000000003110.

  38. Nassar AHM, Hodson J, Ng HJ, Khan MO, Bhatt AN, Griffiths EA. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc. 2020; 34: 4549-4561. doi: 10.1007/s00464-019-07244-3.

  39. Verdaasdonk EG, Stassen LP, Hoffmann WF, van der Elst M, Dankelman J. Can a structured checklist prevent problems with laparoscopic equipment? Surg Endosc. 2008; 22: 2238-2243. doi: 10.1007/s00464-008-9772-9.

  40. Haugen AS, Softeland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, et al. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg. 2015; 261: 821-828. doi: 10.1097/SLA.0000000000000716.

  41. Abbott TEF, Ahmad T, Phull MK, Fowler AJ, Hewson R, Biccard BM, et al. The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis. Br J Anaesth. 2018; 120: 146-155. doi: 10.1016/j.bja.2017.08.004.

  42. Bergs J, Hellings J, Cleemput I, Zurel O, De Troyer V, Van Hiel M, et al. Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. Br J Surg. 2014; 101: 150-158. doi: 10.1002/bjs.9381.

  43. Verdaasdonk EG, Stassen LP, van der Elst M, Karsten TM, Dankelman J. Problems with technical equipment during laparoscopic surgery: an observational study. Surg Endosc. 2007; 21: 275-279. doi: 10.1007/s00464-005-0709-x.

  44. Weerakkody RA, Cheshire NJ, Riga C, Shah S, Hamady MS, Moorthy K, et al. Surgical technology and operating-room safety failures: a systematic review of quantitative studies. BMJ Qual Saf. 2013; 22: 710-718. doi: 10.1136/bmjqs-2012-001750.

  45. Buzink SN, van Lier L, de Hingh IH, Jakimowicz JJ. Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool. Surg Endosc. 2010; 24: 1990-1995. doi: 10.1007/s00464-009-0879-3.

  46. Haugen AS, Waehle HV, Almeland SK, Harthug S, Sevdalis N, Eide GE, et al. Causal analysis of World Health Organization's surgical safety checklist implementation quality and impact on care processes and patient outcomes: secondary analysis from a large stepped wedge cluster randomized controlled trial in Norway. Ann Surg. 2019; 269: 283-290. doi: 10.1097/SLA.0000000000002475.

  47. de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010; 363: 1928-1937. doi: 10.1056/NEJMsa0911535.

  48. de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA. Prevention of surgical malpractice claims by use of a surgical safety checklist. Ann Surg. 2011; 253: 624-628. doi: 10.1097/SLA.0b013e3182068880.

  49. Baron TH, Grimm IS, Swanstrom LL. Interventional approaches to gallbladder disease. N Engl J Med. 2015; 373: 357-365. doi: 10.1056/NEJMra1411581.

  50. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995; 180: 101-125.

  51. Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018; 25: 73-86. doi: 10.1002/jhbp.517.

  52. Seshadri A, Peitzman AB. The difficult cholecystectomy: what you need to know. J Trauma Acute Care Surg. 2024; 97: 325-336.

  53. Pucher PH, Brunt LM, Fanelli RD, Asbun HJ, Aggarwal R. SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc. 2015; 29: 3074-3085. doi: 10.1007/s00464-015-4079-z.

  54. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010; 211: 132-138. doi: 10.1016/j.jamcollsurg.2010.02.053.}

  55. Lin YN, Wu YT, Fu CY, Chen RJ, Hsieh CH, Huang JC, et al. Evaluating the advantages of treating acute cholecystitis by following the Tokyo Guidelines 2018 (TG18): a study emphasizing clinical outcomes and medical expenditures. Surg Endosc. 2021; 35: 6623-6632. doi: 10.1007/s00464-020-08162-7.

  56. Weis J, Brunt LM, Madani A, Bartlett AS, Wynn G, Miskovic D, et al. SAGES Safe Cholecystectomy modules improve practicing surgeons' judgment: results of a randomized, controlled trial. Surg Endosc. 2023; 37: 862-870. doi: 10.1007/s00464-022-09503-4.

  57. Madni TD, Nakonezny PA, Imran JB, Cunningham HB, Taveras LR, Minshall CT, et al. A comparison of cholecystitis grading scales. J Trauma Acute Care Surg. 2019; 86: 471-478. doi: 10.1097/TA.0000000000002146.

  58. Schuster KM, O'Connor R, Cripps M, Wolf L, Quackenbush D, Luckianow G, et al. Multicenter validation of the American Association for the Surgery of Trauma grading scale for acute cholecystitis. J Trauma Acute Care Surg. 2021; 90: 87-96. doi: 10.1097/TA.0000000000002901.

  59. Lee W, Jang JY, Cho JK, Hong SC, Jeong CY. Does surgical difficulty relate to severity of acute cholecystitis? Validation of the Parkland Grading Scale based on intraoperative findings. Am J Surg. 2020; 219: 637-641. doi: 10.1016/j.amjsurg.2019.10.025.

  60. Villani V, Kao LS, Fong Y. The difficult cholecystectomy. JAMA Surg. 2026; 161: 189-196. doi: 10.1001/jamasurg.2025.4199.

  61. Sgaramella LI, Gurrado A, Pasculli A, de Angelis N, Memeo R, Prete FP, et al. The critical view of safety during laparoscopic cholecystectomy: Strasberg yes or no? An Italian multicentre study. Surg Endosc. 2021; 35: 3698-3708. doi: 10.1007/s00464-020-07852-6.

  62. Abe T, Oshita A, Fujikuni N, Noriyuki T, Tanabe K, Itamoto T. Efficacy of bailout surgery for preventing intraoperative biliary injury in acute cholecystitis. Surg Endosc. 2023; 37: 2595-2603. doi: 10.1007/s00464-022-09755-0.

  63. Mascagni P, Rodríguez-Luna MR, Urade T, Vardazaryan A, Felli E, Falconi M, et al. Intraoperative time-out to promote the implementation of the critical view of safety in laparoscopic cholecystectomy: a video-based assessment of 343 procedures. J Am Coll Surg. 2021; 233: 497-505. doi: 10.1016/j.jamcollsurg.2021.06.018.

  64. van Dalen ASHM, Swinkels JA, Coolen S, Hackett R, Schijven MP. Improving teamwork and communication in the operating room by introducing the theatre cap challenge. J Perioper Pract. 2022; 32: 4-9. doi: 10.1177/17504589211046723.

  65. Way LW, Stewart L, Gantert W, Liu K, Lee C, Whang K, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003; 237: 460-469. doi: 10.1097/00000658-200304000-00004.

  66. Lim PW, Tan PH, Lillemoe KD, Nelson MH, Johnston PF, Jorge IA, et al. A 10-year real world assessment of longitudinal outcomes following bailout procedures for severe cholecystitis. Ann Surg. 2025; 282: 553-562. doi: 10.1097/SLA.0000000000006799.

  67. Dhanasekara CS, Shrestha K, Grossman H, Garcia LM, Maqbool B, Luppens C, et al. A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: a multicenter real-world study. Surgery. 2024; 176: 605-613. doi: 10.1016/j.surg.2024.03.057.

  68. Strasberg SM. A three-step conceptual roadmap... J Hepatobiliary Pancreat Sci. 2019; 26: 123-127.

  69. Brunt LM, Telem DA, Deziel DJ, Strasberg SM, Stefanidis D. Response to Comment on "Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury (BDI) during cholecystectomy". Ann Surg. 2021; 274: e812-e813.

  70. Hope WW, Fanelli R, Walsh DS, Narula VK, Price R, Stefanidis D, et al. SAGES clinical spotlight review: intraoperative cholangiography. Surg Endosc. 2017; 31: 2007-2016. doi: 10.1007/s00464-016-5320-0.

  71. Sheffield KM, Riall TS, Han Y, Kuo YF, Townsend CM Jr, Goodwin JS. Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury. JAMA. 2013; 310: 812-820. doi: 10.1001/jama.2013.276205.

  72. Ford JA, Soop M, Du J, Loveday BP, Rodgers M. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg. 2012; 99: 160-167. doi: 10.1002/bjs.7809.

  73. Kovács N, Németh D, Foldi M, Nagy B, Bunduc S, Hegyi P, et al. Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis. Surg Endosc. 2022; 36: 7126-7139. doi: 10.1007/s00464-022-09267-x.

  74. Dreifuss NH, Lendoire M, McCormack L, Capitanich P, Iovaldi ML, Schlottmann F. When should we perform intraoperative cholangiography? A prospective assessment of 1000 consecutive laparoscopic cholecystectomies. Surg Laparosc Endosc Percutan Tech. 2021; 32: 3-8. doi: 10.1097/SLE.0000000000000985.

  75. Iranmanesh P, Tobler O, De Sousa S, Borel Rinkes IH, Morel P, Bjelovic M, et al. Feasibility, benefit and risk of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy. PLoS One. 2018; 13: e0199147. doi: 10.1371/journal.pone.0199147.

  76. Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, et al. Biliary anatomy visualization and surgeon satisfaction using standard cholangiography versus indocyanine green fluorescent cholangiography during elective laparoscopic cholecystectomy: a randomized controlled trial. J Clin Med. 2024; 13: 864. doi: 10.3390/jcm13030864.

  77. Lim SH, Tan HTA, Shelat VG. Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy: a meta-analysis. Surg Endosc. 2021; 35: 1511-1520. doi: 10.1007/s00464-020-08164-5.

  78. Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for "difficult gallbladders": systematic review and meta-analysis. JAMA Surg. 2015; 150: 159-168. doi: 10.1001/jamasurg.2014.1219.

  79. Nadeem MA, Awan AR, Wehrle CJ, Tsutsumi A, Darby F, Bhandarkar S, et al. Operative strategies for the acute difficult gallbladder: a Society for Surgery of the Alimentary Tract state-of-the-art systematic review and meta-analysis of subtotal cholecystectomy outcomes. J Gastrointest Surg. 2026; 30: 102345. doi: 10.1016/j.gassur.2026.102345.

  80. Deng SX, Greene B, Habbel C, Bubis L, Tsang ME, Jayaraman S. Management of bile leak post minimally invasive subtotal cholecystectomy: a review. Ann Surg. 2026; 283: 219-224. doi: 10.1097/SLA.0000000000006744.

  81. Qandeel H, Hayyawi I, Nassar AHM, Ng HJ, Hay J, Griffin SM, et al. The rationale of sub-hepatic drainage on a specialist biliary unit: a review of 6140 elective and urgent laparoscopic cholecystectomies and bile duct explorations. Langenbecks Arch Surg. 2024; 409: 271. doi: 10.1007/s00423-024-03459-w.

  82. Gurusamy KS, Koti R, Davidson BR. Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2013; 9: CD006004. doi: 10.1002/14651858.CD006004.pub4.

  83. Yang J, Liu Y, Yan P, Li Y, Pei Q, Tan M, et al. Comparison of laparoscopic cholecystectomy with and without abdominal drainage in patients with non-complicated benign gallbladder disease: a protocol for systematic review and meta-analysis. Medicine. 2020; 99: e20070. doi: 10.1097/MD.0000000000020070.

  84. Yong L, Guang B. Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy: a systematic review with meta-analysis and trial sequential analysis. Int J Surg. 2016; 36: 358-368. doi: 10.1016/j.ijsu.2016.11.083.

  85. Haidar H, Manasa E, Yassin K, Shirin G, Khatib N, Goldberg Y, et al. Endoscopic treatment of post-cholecystectomy bile leaks: a tertiary center experience. Surg Endosc. 2021; 35: 1088-1092. doi: 10.1007/s00464-020-07472-0.

  86. Ramírez-Giraldo C, Monroy DC, Isaza-Restrepo A, Buitrago-Gutierrez G, Gomez-Ochoa S, Vera-Arroyo LE, et al. Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study. Surg Endosc. 2024; 38: 4965-4975. doi: 10.1007/s00464-024-10911-x.

  87. Grossman H, Holder KG, Freedle C, Dhanasekara CS, Dissanaike S. Comparing outcomes of sub-total cholecystectomy versus open cholecystectomy as bailout procedures for the difficult gallbladder. Am Surg. 2023; 89: 5372-5378. doi: 10.1177/00031348221148345.

  88. Humes DJ, Ahmed I, Lobo DN. The pedicle effect and direct coupling: delayed thermal injuries to the bile duct after laparoscopic cholecystectomy. Arch Surg. 2010; 145: 96-98. doi: 10.1001/archsurg.2009.236.

  89. Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME, et al. Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg. 1992; 215: 196-202. doi: 10.1097/00000658-199203000-00002.

  90. Barrat C, Capelluto E, Champault G. Intraperitoneal thermal variations during laparoscopic surgery. Surg Endosc. 1999; 13: 136-138. doi: 10.1007/s004649900922.

  91. Iwashita Y, Hibi T, Ohyama T, Umezawa A, Takada T, Strasberg SM, et al. Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework? J Hepatobiliary Pancreat Sci. 2017; 24: 591-602. doi: 10.1002/jhbp.503.

  92. Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the LigaSure. Br J Surg. 2010; 97: 428-433. doi: 10.1002/bjs.6901.

  93. Portella AO, Trindade MR, Dias LZ, Goldenberg S, Trindade EN. Monopolar electrosurgery on the extrahepatic bile ducts during laparoscopic cholecystectomy: an experimental controlled trial. Surg Laparosc Endosc Percutan Tech. 2009; 19: 213-216. doi: 10.1097/SLE.0b013e3181a44592.

  94. Hefermehl LJ, Largo RA, Hermanns T, Imkamp F, Strebel RT, Zimmermann M, et al. Lateral temperature spread of monopolar, bipolar and ultrasonic instruments for robot-assisted laparoscopic surgery. BJU Int. 2014; 114: 245-252. doi: 10.1111/bju.12498.

  95. Shibao K, Joden F, Adachi Y, Shiraishi N, Mimori K, Mori M, et al. Repeated partial tissue bite with inadequate cooling time for an energy device may cause thermal injury. Surg Endosc. 2021; 35: 3189-3198. doi: 10.1007/s00464-021-08322-3.




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