{
  "abstract": "Intraoperative cholangiography (IOC) during cholecystectomy can be useful for detecting gallstones in the bile duct, and for delineating bile duct anatomy to avoid or detect bile duct injury. Historically many surgeons considered IOC necessary in every case, particularly in the early years following the uptake of laparoscopic cholecystectomy (LC).Forty years later, despite contemporary evidence not supporting routine practice of IOC, many practitioners still advocate it. While IOC does detect bile duct stones, it can result in overdiagnosis of ‘stones’ that either are not stones at all, or are small stones that will subsequently pass into the duodenum without incident. This leads to much unnecessary treatment that carries with it significant complications and impacts. Furthermore, in the current context of thorough training in LC and refinements of anatomical identification and dissection techniques, routine IOC is not associated with decrease in bile duct injuries.We are embarking on a broad study to determine the real clinical value of routine IOC, and to define pre-operative factors that predict the presence of main bile duct stones and thereby selectively mandate an IOC during LC. In the interim, as the integral first phase of the study, this paper describes the impact of this diagnostic intervention in terms of extra cost incurred, carbon footprint of consumables and extra energy usage, additional burden on operating theatre time that is always at a premium, and further treatments that may prove to be unnecessary and even harmful.While IOC can be a useful diagnostic intervention, we believe it should be selectively applied in the correct clinical context. We present here a summary of its financial, environmental, workflow and clinical impacts, to aid in maximising the sustainable value of its practice.",
  "authors": [
    {
      "affiliations": [
        "John Hunter Hospital, Newcastle, Australia"
      ],
      "name": "Stanley Chen"
    },
    {
      "affiliations": [
        "John Hunter Hospital, Newcastle, Australia"
      ],
      "name": "Nicholas Bull"
    }
  ],
  "title": "099 Impacts of intra-operative cholangiography, an operative intervention with the potential for overdiagnosis",
  "uid": "002fe2fb-b2b7-5fe8-b801-415d7f80e953"
}