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The Pedicle Effect and Direct Coupling:  Delayed Thermal Injuries to the Bile Duct After Laparoscopic Cholecystectomy

David J. Humes, MRCS; Irfan Ahmed, MD, FRCS; Dileep N. Lobo, DM, FRCS
Arch Surg. 2010;145(1):96-98. doi:10.1001/archsurg.2009.236.
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Electrothermal energy, especially in the form of monopolar diathermy, is used widely for dissection during laparoscopic cholecystectomy. While this is largely safe, occasionally there can be unrecognized transfer of energy in the operating area, resulting in electrothermal injury. We report a series of 3 patients who underwent uneventful laparoscopic cholecystectomies but were readmitted 4 to 5 days later with pinhole leaks from the common bile duct as a result of coagulative necrosis caused by unrecognized energy transfer. We suggest that surgeons keep the use of monopolar diathermy to a minimum while dissecting near vital structures.

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Figure 1.

Intraoperative photograph demonstrating a pinhole perforation (arrow) in the common bile duct. The titanium clips (arrowhead) on the cystic duct stump are in place.

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Figure 2.

Endoscopic retrograde cholangiopancreatography showing extravasation of contrast (arrowhead) from the common bile duct, just distal to the insertion of the cystic duct.

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