Safe Cholecystectomy as a Competency-based Teaching Method to Prevent Bile Duct Disruption

Despite the benefits of laparoscopic cholecystectomy, the incidence of bile duct disruption has increased significantly over the years, from a range of 0.1 to 0.2% during the open cholecystectomy (CA) era to a range of 0.4 to 0.6% in the laparoscopic cholecystectomy (LC) era. and 0.72% per year in single-port cholecystectomy. Most prevention or safety interventions alone have not achieved adequate implementation and outcomes in terms of bile duct injury have remained largely unchanged. Nothing could be further from the truth than trying to establish infallible formulas for the prevention of surgical injuries of the bile duct. Bile duct injury secondary to cholecystectomy is one of the most catastrophic complications for both the patient and the surgeon due to its repercussions. The main factor in addressing this problem is prevention, performing gentle and careful surgical technique, recognizing when the situation is beyond the surgeon's ability, and being vigilant to ask for experienced help. It must be recognized that the latter and the decision to convert are not signs of incapacity, but of good judgment. Perhaps one of the most important principles is to keep in mind that any surgeon can present them. Only from this premise can the recommendations of the 10 high safety requirements and the 7 transoperative maneuvers for a safe cholecystectomy be useful, which together with a structured and competency-based teaching-learning process can further reduce the rate of surgical disruption of the bile duct.