We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Patient Safety in Laparoscopic Cholecystectomy

Brij B. Agarwal, MBBS, MS, Dip Yoga, FIMSA
Arch Surg. 2009;144(10):977-980. doi:10.1001/archsurg.2009.180.
Text Size: A A A
Published online


Fluorescent cholangiography improves outcomes of LC.1 Fluorescent cholangiography is a welcome addition to the surgical tools available for the “new world of patient safety,”2 helping to deliver the best to all patients, all the time. Bile duct injury–prevention strategies focus on avoiding misidentification of biliary anatomy owing to misperception. Structured granting of professional privileges, judicious avoidance of energized dissection, and the systems approach have helped,3 but the risk of human error2 due to spatial disorientation leading to psychoheuristic cognitive ambiguity continues to haunt the BDI-fearing surgeon.4 Risk of error is high in LC because the operator does not manipulate reality directly but works from images.4 This video-perceptive illusion, ie, error of perception from working indirectly, is disastrous. Even minor errors may result in BDI. Fluorescent cholangiography neither needs additional resources (besides an optic filter) nor increases the invasiveness of LC.1 Fluorescent cholangiography facilitates the clear interpretation of biliary anatomy. It minimizes cognitive error by allowing surgeons to believe what they see rather than trying to see what they believe. Fluorescent cholangiography pre-empts any possibility of video-perceptive heuristics going wrong. It augments the cognitive skill of physicians, enabling them to execute surgical movements as planned and envisioned mentally.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles