In the ongoing effort to enhance patient safety in laparoscopic surgery Domenech Asbun, M.D., a hepatobiliary and pancreatic surgeon at Baptist Health Miami Cancer Institute, has emerged as a leading advocate for implementing evidence-based practice guidelines that can significantly reduce complications during gallbladder surgery.

Laparoscopic cholecystectomy has become the gold standard for gallbladder removal, with more than 750,000 procedures performed annually in the U.S. However, the widespread adoption of this minimally invasive technique initially came with an unexpected drawback: Bile duct injuries were occurring at a much higher rate than during traditional open procedures. Although outcomes have improved significantly, this is still an important complication that surgeons must be aware of.

Domenech Asbun, M.D.

“These surgeries are considered relatively simple, but you must approach each one with great care,” Dr. Asbun says. “When you have a bile duct injury, there can be very real and serious consequences to patients. There is a straightforward way to lessen the chance of a bile duct injury, and that is to follow the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) teachings, which include the Critical View of Safety.”

Dr. Asbun is championing the educational initiatives developed through SAGES, which includes multi-society consensus guidelines. His work focuses on translating the comprehensive safety recommendations, which physicians at Miami Cancer Institute helped develop, into practical, teachable protocols.

Obtaining the Critical View of Safety involves clearing the hepatocystic triangle of fibrofatty tissue, separating the lower third of the gallbladder from the liver’s cystic plate and confirming that two, and only two, structures are connected to the gallbladder. SAGES guidelines further advocate for other safe practices, including an intraoperative pause before cutting any ductal structures. Ductal identification during a laparoscopic cholecystectomy minimizes the risk of a bile duct injury.

Dr. Asbun has specifically designed an International Safe Cholecystectomy course to reach surgeons in low and middle-income countries, home to approximately 90 percent of the world’s population. There, access to advanced surgical training and healthcare resources remains limited. Through this targeted international outreach, he aims to ensure that the lifesaving techniques and safety protocols developed at leading medical institutions can be effectively implemented in underserved communities worldwide.

“This is critical information for countries in which limited resources and socioeconomic disparities have an exponential impact on complications after cholecystectomy. We work with a local champion surgeon in the area to determine how to make the course as useful to them and their particular circumstances as possible,” Dr. Asbun says.

The three-day remote program includes lectures and group discussions on topics such as anatomy, cholecystectomy technique, tips to manage difficult situations and management of bile duct injuries. There is also a pre- and post-course evaluation. The course has been held in two different countries, and four more courses are currently being organized across three countries. Information is equally pertinent for physicians in the U.S.

For more details on Dr. Asbun’s course, contact Domenech.Asbun@baptisthealth.net.