The importance of cognitive map placement in bile duct injuries.

SUMMARY: Bile duct injuries often occur because of surgeon spatial disorientation. The psychological concept of cognitive map misplacement is a useful explanation of how this disorientation and injury occurs. Surgeons may find that using a "bile duct time out" is a helpful way to orient. Based on the mnemonic B-SAFE, they can use 5 subhepatic landmarks (B, bile duct; S, sulcus of Rouviere; A, hepatic artery; F, umbilical fissure; E, enteric/duodenum) to correctly place their cognitive map.