Laparoscopic cholecystectomy incurs the same risks as conventional cholecystectomy, in addition to the risks associated with
laparoscopy. However, because cholecystectomy was really the “boom” for therapeuti laparoscopy, its complications have always
been highly publicized and scrutinized. As unconscionable as it may seem, learning curves are all too real, and some patients
undoubtedly suffer as technology advances to help the masses. For the individual surgeon, however, the learning curve should
have nothing to do with the safety or soundness of the procedure, for these are absolute and can never be compromised. Rather,
the learning curve should only determine how long it takes to perform the task and the circumstances under which the surgeon
requests assistance. Optimistically, the steep portion of the collective laparoscopic cholecystectomy learning curve appears
to be in the past.
Whether an open technique is used to gain peritoneal access, whether a cholangiogram is performed routinely, or whether a
gallbladder is removed from the fundus down, understanding the complications of laparoscopic cholecystectomy will facilitate
a safer procedure. Although pioneering minimally invasive techniques demands creativity, surgeons should strive to duplicate
the excellent results claimed by history’s champions of open cholecystectomy.
Medicolegal attention has forced many surgeons to practice “defensive” medicine when it comes to managin patients with pain
or unexplained fever following laparoscopic cholecystectomy. However, a high index of suspicion for injury, a low threshold
to perform diagnostic tests, and liberal use of expert consultation may lead to earlier recognition of injury and improved
outcome.