Know The Indications For Intraoperative Cholangiogram - From my point of view as a practicing St Louis injury attorney, a surgeon should always do one. I am not alone, several surgeons agree, one surgeon wrote:
Cholangiogram! Really no excuse not to do one. You'll feel better about the case if you make cholangiography a routine part of your technique [...] since I've been in practice I plan to do one on every LC. It doesn't add much time. It really doesn't. And the more you do, the faster it goes. Anymore, if I don't do a cholangiogram for some reason (dye leakage, patient body habitus, etc.) I feel like you would if you went to work one day and realized at noon that your zipper had been down all day. A nice cholangiogram just makes me feel all warm and fuzzy inside.
There is no reason for a surgeon to do an intraoperative cholangiogram (IOC) to verify the exact anatomy of the biliary tree and the location of the common duct before clipping and cutting the cystic duct, thus preventing a common reason for St Louis medical malpractice from gallbladder removal. Many surgeons, particularly those practicing in a university setting, suggest that IOC be used in every lap choli case.
Most hospitals do not believe (at least they claim they do not) that a cholangiogram is required to meet the standard of care, they will require it after a surgeon commits gallbladder removal medical malpractice a few times, only then make it a condition of the surgeon's continued staff privileges.
A Cholangiogram is important in laparoscopic cholecystectomy because it clarifies the anatomy of the biliary tree. A Sun Tzu's Art of War states - Know the Terrain before going into battle i.e. know the anatomy before going into surgery, and a cholangiogram is a critical tool for knowing the anatomy. It provides the opportunity to see everything well before cutting anything while keeping dissection away from the area where almost all biliary anomalies would be encountered: the triangle of Calot.
