Patients support transfer of care for unexpected findings in laparoscopic cholecystectomy

  • Shanley B. DealEmail author
  • Jennifer A. Rich
  • Elizabeth Carlson
  • Guillaume S. Chevrollier
  • Michael J. Pucci
  • Adnan A. Alseidi



Surgeons often assume patients may be dissatisfied if their operations were stopped due to suspicious intraoperative findings requiring transfer of care. We sought to assess patient opinions regarding transfer of care for unexpected intraoperative findings during laparoscopic cholecystectomy with and without bile duct injury (BDI).

Methods and procedures

The investigators developed two clinical scenarios comparing transfer of care for unexpected intraoperative findings during elective laparoscopic cholecystectomy: without BDI and with BDI requiring open repair. A multi-institutional structured telephone interview process was conducted with patients ≥ 18 years of age who had an outpatient, uncomplicated laparoscopic cholecystectomy within the last year. The first scenario presented a case of suspicious findings prompting the surgeon to stop and transfer for specialized care; whereas the second case was a BDI requiring transfer of care. Textual and thematic analysis as well as descriptive statistics was used for analysis, with significance set at p < 0.05.


Forty-five patients completed the survey. Satisfaction with transfer of care for unexpected intraoperative findings without BDI was 69%, and over 95% of respondents were satisfied their surgeon stopped the procedure to initiate transfer due to safety concerns; 64% of patients would return to that surgeon for postoperative care; and 78% would see that surgeon again. In the scenario with BDI requiring open repair, 86% were satisfied with their surgeon’s decision to stop the operation; 91% of patients were satisfied with transfer of care; and 32% would see their first surgeon again. Themes of prioritizing safety and transparency were frequently cited.


Patients prioritize safety and are satisfied with halting a procedure to facilitate transfer of care for suspicious intraoperative findings during routine laparoscopic cholecystectomy.


Laparoscopic cholecystectomy Patient-centered care Bile duct injury Patient perceptions Transfer of care 


Compliance with ethical standards


The authors, Shanley Deal, Jessica Rich, Elizabeth Carlson, Guillaume Chevrollier, Michael Pucci, and Adnan Alseidi, have no conflicts of interest or financial ties to disclose.


  1. 1.
    Buddingh KT, Morks AN, ten Cate Hoedemaker HO, Blaauw CB, van Dam GM, Ploeg RJ et al (2012) Documenting correct assessment of biliary anatomy during laparoscopic cholecystectomy. Surg Endosc 26(1):79–85CrossRefGoogle Scholar
  2. 2.
    Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H (2015) Subtotal cholecystectomy for “difficult gallbladders”: systematic review and meta-analysis. JAMA Surg 150(2):159–168CrossRefGoogle Scholar
  3. 3.
    Nijssen MA, Schreinemakers JM, van der Schelling GP, Crolla RM, Rijken AM (2016) Improving critical view of safety in laparoscopic cholecystectomy by teaching interventions. J Surg Educ 73(3):442–447CrossRefGoogle Scholar
  4. 4.
    Sanford DE, Strasberg SM (2014) A simple effective method for generation of a permanent record of the Critical View of Safety during laparoscopic cholecystectomy by intraoperative “doublet” photography. J Am Coll Surg 218(2):170–178CrossRefGoogle Scholar
  5. 5.
    Strasberg SM (2013) A teaching program for the “culture of safety in cholecystectomy” and avoidance of bile duct injury. J Am Coll Surg 217(4):751CrossRefGoogle Scholar
  6. 6.
    Strasberg SM, Brunt LM (2017) The critical view of safety: why it is not the only method of ductal identification within the standard of care in laparoscopic cholecystectomy. Ann Surg 265(3):464–465CrossRefGoogle Scholar
  7. 7.
    State-of the-Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy: Consensus Recommendations.
  8. 8.
    Melton GB, Lillemoe KD, Cameron JL, Sauter PA, Coleman J, Yeo CJ (2002) Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life. Ann Surg 235(6):888–895CrossRefGoogle Scholar
  9. 9.
    Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L (2003) Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 290(16):2168–2173CrossRefGoogle Scholar
  10. 10.
    Dolan JP, Diggs BS, Sheppard BC, Hunter JG (2005) Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc 19(7):967–973CrossRefGoogle Scholar
  11. 11.
    Walsh RM, Henderson JM, Vogt DP, Brown N (2007) Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 142(4):450–456 (discussion 6–7) CrossRefGoogle Scholar
  12. 12.
    Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA et al (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 241(5):786–792 (discussion 93–5) CrossRefGoogle Scholar
  13. 13.
    Buell JF, Cronin DC, Funaki B, Koffron A, Yoshida A, Lo A et al (2002) Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch Surg 137(6):703–708CrossRefGoogle Scholar
  14. 14.
    Mercado MA (2006) Early versus late repair of bile duct injuries. Surg Endosc 20(11):1644–1647CrossRefGoogle Scholar
  15. 15.
    Mercado MA, Chan C, Orozco H, Hinojosa CA, Podgaetz E, Ramos-Gallardo G et al (2005) Prognostic implications of preserved bile duct confluence after iatrogenic injury. Hepatogastroenterology 52(61):40–44PubMedGoogle Scholar
  16. 16.
    Johnson SR, Koehler A, Pennington LK, Hanto DW (2000) Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy. Surgery 128(4):668–677CrossRefGoogle Scholar
  17. 17.
    Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237(4):460–469PubMedPubMedCentralGoogle Scholar
  18. 18.
    The SAGES Safe Cholecystectomy Program.
  19. 19.
    Strasberg SM (2019) A three step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy. J Hepat Pancreat Sci 26:123–127CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Virginia Mason Medical Center, General, Thoracic and Vascular SurgerySeattleUSA
  2. 2.Sidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations