They happen when you think it's easy."
The solution, says Dr. Horgan, is at surgeons' fingertips. "Click a but-
ton, and that [white light] image becomes that [fluorescent-lit] image,
and suddenly you have a 100% guarantee that you are not clipping the
common bile duct," he says. "Now we know exactly where the anato-
my is." Two minutes with intraoperative contrast imaging, he adds,
gives you what X-rays take 11 minutes to do. "This could change how
surgery happens in the OR," he says.
A diagnostic advantage
In addition to its safety benefits, image enhancement technology ele-
vates minimally invasive surgeons' diagnostic powers and may even
improve their likelihood of achieving successful outcomes. During
upper and lower GI tract screenings, for instance, specially filtered
illumination or digital image processing can help to highlight subtle
M A Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 8 1
PRACTICE PRECAUTIONS
Making Lap Chole Safer
The use of image enhancement technology is a key
component of the Society of American
Gastrointestinal and Endoscopic Surgeons' Safe
Cholecystectomy Program (osmag.net/h4uSSH), a
set of guidelines that aim to minimize bile duct
injuries during the laparoscopic procedure. Other
steps include using the Critical View of Safety
method to identify anatomy, taking an intra-operative
time out before cutting ductal structures, under-
standing the possibility of anatomical aberrations,
recognizing dangerous dissections and changing course if necessary, and calling in another sur-
geon for help. — David Bernard
• SAFE ENTRY Lap chole cases demand their own culture
of safety, says SAGES.
