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Introduction: The commonest cause of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is the confusion of bile duct with cystic duct. Operation notes must include the anatomical rationale by which the cystic duct was conclusively identified.

Aim: To examine the quality of documentation and the terms used to describe the method/methods utilised to identify the cystic duct during laparoscopic cholecystectomy.

Method: The documentation of the method/s used for cystic duct identification was examined in 322 consecutive non-converted LCs that were carried out between the months of August 2010 and January 2011. Non-protocolised operation notes were studied and stratified into different groups according to the descriptive terms used. The strata included: 1). No documentation of the method used, 2). Calot’s triangle was dissected or demonstrated, 3) Infundibular or infundibulo-cystic technique used, 4). Critical view of safety (CVS) demonstrated, 5) Intra-operative cholangiogram used, or 6) Other methods.

Results: Demonstration of the critical view of safety was documented in (4/310) 1.3% of the cases. Infundibular or infundibulo-cystic technique was used to define the cystic duct in (9/310) 3.4% of the notes. Calot’s triangle was mentioned in (255/310) 82.3% of the notes. In (43/310) 13.9% of cases, the cystic artery and duct were mentioned without any reference to critical view of safety, infundibular / infundibulo-cystic technique or Calot’s triangle.

Conclusion: Written documentation of the method of cystic duct identification in the operation notes during LC is sub-optimal. We, hence recommend standardization of the cholecystectomy operative report, inclusion of a video clip and/ or photo image using digital information and communication in medicine (DICOM) to complement the textual operation notes and move towards structured computerised input that links to the picture archiving and communication system (PACS).