January 17, 2020

In November 2019, a Georgia medical malpractice jury returned its verdict in the amount of one million dollars, which included over $320,000 in medical expenses and lost wages for the plaintiff. The defendants were the general surgeon who performed the laparoscopic cholesectomy on the plaintiff and her medical group.

The plaintiff’s Georgia medical malpractice lawsuit alleged that the defendant surgeon negligently performed the outpatient gall bladder surgery on the plaintiff that resulted in a partial liver resection and bile duct reconstruction. The plaintiff’s medical malpractice attorney explained, “Unfortunately, Dr. Aho failed to correctly identify what she was cutting and clipping and injured both Mr. Carmen’s liver and remaining bile duct. There are two main techniques surgeons are supposed to use to confirm they are in the correct area and cutting correct structures when removing a patient’s gallbladder. All of the medical experts in the case agreed that these techniques are the standard of care, and that if they are followed, incorrect structures should not be injured during gallbladder removal.”

The plaintiff’s Georgia medical malpractice lawsuit alleged that the defendant surgeon caused injury to the plaintiff’s blood vessels that supplied oxygen to the right side of his liver, which caused a portion of the plaintiff’s liver to die and required a partial resection of his liver. The defendant general surgeon also injured the duct that drains bile from the plaintiff’s liver, thereby requiring reconstruction surgery to repair the injury.


Laparoscopic cholecystectomy was first performed by the German professor, Muhe, in 1985. Approximately 500,000 cholecystectomies were performed each year in the United States in the late 1990s, and most were performed laparoscopically.

The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. It is associated with an overall complication rate of approximately ten percent with a higher risk of biliary injury (0.1%-1.5%) when compared to the open approach (0.1%-0.2%). “[I]t is important to recognize the fact that most of these injuries are preventable, especially if a structured safe technical protocol is followed.”

Safe Laparoscopic Cholesectomy

“Basic tenets of performing a safe LC include: (1) Thorough knowledge of surgically relevant anatomy; (2) Identification of factors predictive of difficult cholecystectomy; (3) Understanding and execution of correct technique that includes: Correct exposure/display of hepatocystic (HC) triangle in preparation of dissection; Judicious use of energy sources; Achieving the critical view of safety (CVS); Remembering error traps; (4) Strategies to handle a difficult situation: Stopping rules; Second opinion/surgical assistance; Use of intraoperative imaging to clarify the anatomy; Bail-out procedures; and (5) Documentation.”

“It is crucial to have a thorough knowledge of the relevant anatomy as the procedure is performed in an area adjacent to many vital structures (portal vein, hepatic artery and extrahepatic biliary tract). Furthermore, the surgeon needs to be mindful of common anatomical variations, and the anatomical distortion due to pathological processes (e.g., acute/chronic cholecystitis).”

“It is important for the operating surgeon to be able to recognize during the procedure when the dissection is becoming unsafe with a high potential for biliary/vascular injury. Prudence lies in realizing this danger much before the procedure continues in to the zone of great risk so that the procedure can be stopped at a point of safe return. Thus the operating surgeon should be able to identify or pre-empt the difficult situation that might increase the risk of biliary/vascular injury with the help of certain red flags.”

“It is advisable that operating surgeon should take a pause and seek a second opinion from another surgeon in event of any unexpected finding, a difficult gallbladder, unusual anatomy, or a difficult dissection. Misidentification is the major cause of biliary/vascular injury, and most commonly (65%) the CBD/CHD is misidentified as the cystic duct or the hepatic artery is misidentified as the cystic artery (10%).”

“The surgeon should remember that a 95% cholecystectomy (i.e., STC) is always safer than a 100+% cholecystectomy where variable portion of the bile duct is also excised along with gallbladder, and bile leak from gallbladder is always safer (i.e., dissection very close to gallbladder wall) then from the bile duct.”


If you or a loved one may have been injured due to a botched cholesectomy in Georgia or in another U.S. state, you should promptly find a Georgia medical malpractice lawyer, or a medical malpractice lawyer in your state, who may investigate your cholesectomy negligence claim for you and represent you in a cholesectomy medical malpractice case, if appropriate.

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