Laparoscopic gallbladder removal is one of the safest, most routine operations in American medicine. The critical view of safety, a required checkpoint during surgery where the surgeon confirms exactly which structures they are cutting before making further decisions.
If this technique is skipped, patients can suffer severe bile duct injuries including the transection of the common bile duct, the common hepatic duct, and the right hepatic artery – three separate structures that shouldn’t be touched during a gallbladder removal.
During a standard laparoscopic gallbladder surgery, two to six surgical clips are typically used to safely seal off blood vessels and the duct that connects the gallbladder to the main bile duct. If transection occurs, a surgeon has a responsibility to use proper techniques to control the bleeding and ultimately repair the mistake.
For major arterial transections – the common hepatic artery and right hepatic artery – the ends are typically oversewn with vascular sutures rather than closed with standard clips to prevent bleeding. Repairing the bile duct transection is usually managed with a biliary reconstruction because clipping a major bile duct could cause biliary obstruction.
In this case, the performing surgeon did not follow proper protocols and did not use proper techniques. When our client began bleeding during surgery because the common bile duct, common hepatic artery, and right hepatic artery were transected, his surgeon placed upward of 20 clips on structures he could not identify. The injuries our client suffered due to these mistakes went undiagnosed for five weeks.
The Townsley Law Firm fought for our client and recovered over $4,500,000 in a settlement.
Sections of this blog
The Critical View of Safety: One Checkpoint That Prevents This Exact Injury
Our client went into the hospital for a laparoscopic cholecystectomy, a minimally invasive surgery to remove the gallbladder. This surgery is the standard treatment for painful gallstones, chronic inflammation, or biliary dyskinesia, and usually takes 60-to-90 minutes to perform. Because the surgery is done “laparoscopically,” four small incisions are made, allowing a camera and specialized tools to safely extract the gallbladder.
Before any clip is applied or any structure divided in a laparoscopic cholecystectomy, accepted surgical practice requires the surgeon to dissect the area until only two structures are visibly entering the gallbladder: the cystic duct and the cystic artery. Nothing gets cut until that view is achieved and, ideally, photographed for the record. This is not an optional refinement. It is the defined standard of care, developed specifically because bile duct injuries during this procedure are devastating and largely preventable.
When a surgeon proceeds without that view, the common bile duct sitting just beside the cystic duct can be mistaken for it and cut. That is the classic mechanism of catastrophic bile duct injury, compounded by injury to the hepatic duct and right hepatic artery as well.
When excessive bleeding is discovered, due to the transection of the bile duct, hepatic duct, and hepatic artery, the standard of care requires a surgeon to stop the surgery, get intraoperative imaging, call for help, or convert to an open procedure.
Our client’s surgeon did none of those things. After losing over 1000 cc’s of blood, which is considered a severe hemorrhage requiring close monitoring or transfusions, our client’s surgeon put 20-plus clips on unidentified structures, clear evidence that the critical view was never established. A surgeon who knows anatomy does not blindly clip 20 sites to stop bleeding.
Five Weeks Turned a Surgical Error Into a Near-Fatal Cascade
A bile duct injury caught during surgery, or even in the first day or two afterward, can often be repaired with a manageable outcome. In this case, however, our client’s diagnosis was delayed. For five weeks, bile leaked into his abdomen, his disrupted blood supply went unaddressed, and his injuries went undiagnosed and untreated.
The result was a chain of complications. Our client experienced septic shock, renal failure, pneumonia, respiratory failure, and a bloodstream infection. He also suffered liver damage severe enough to cause ascites (fluid accumulation in the abdomen), bilomas (collections of leaked bile), malnutrition, and critical illness myopathy, the profound muscle weakness that develops in patients who spend long periods critically ill.
He was too sick to undergo corrective surgery for three months. Only after his body had stabilized could a specialist perform the liver reconstruction his original surgeon’s errors made necessary. Months more of hospitalization and rehabilitation followed.
He survived with permanent disability. The total picture, months of inpatient care, repeated procedures, and lasting impairment, all traced back to one skipped safety step and a diagnosis that came five weeks too late.
Frequently Asked Questions
Is every bile duct injury during gallbladder surgery malpractice?
No. Bile duct injury is a recognized risk of the procedure, and not every occurrence is negligence. What points to malpractice is how it happened: a failure to perform the critical view of safety, cutting structures that were never properly identified, or, as in this case, placing numerous clips on unidentified anatomy. Whether the standard of care was met is a question for medical experts reviewing the operative record.
What does it mean that the surgeon didn’t use the “critical view of safety”?
The critical view of safety is the required step where the surgeon clearly exposes and confirms the two structures connecting to the gallbladder before cutting anything. Skipping it dramatically raises the risk of mistaking the common bile duct for the cystic duct and cutting the wrong structure. Its omission is frequently the central issue in a bile duct injury malpractice claim.
Why was the five-week delay so significant?
Timing largely determines the outcome in bile duct injuries. Recognized and repaired early, the damage can be contained. Left undiagnosed for five weeks, leaking bile and disrupted blood flow drove this patient into septic shock, organ failure, and a string of life-threatening complications that a prompt diagnosis would likely have prevented. The delay, not just the original cut, is what turned a surgical error into a near-fatal event.
What are bilomas and ascites, and why do they matter here?
A biloma is a pocket of bile that has leaked out of the biliary system and collected in the body. Ascites is a buildup of fluid in the abdominal cavity, often a sign of significant liver injury or disease. Both developing after a gallbladder surgery are red flags that something has gone seriously wrong with the bile ducts or liver, and both were present in this patient as his undiagnosed injuries progressed.
