errors were related to misidentifying the bile duct. Dekker and Hugh attribute these errors to certain psychological phenomena that include inability to read cues, inability to slow oneself during surgical procedures, and a belief that the risk is low during operation. Dekker and Hugh also emphasize the need to train surgeons to apply “stopping rules” when necessary during an operation and to train surgeons to accept the need for plan modication, which reminds us that Moulton’s personality characteristics may be an important consideration. This phenomenon has been described as cognitive xation and plan continuation by these authors. For example, if a surgeon makes a decision to go in one direction, but it is not the correct decision, it is more dif­cult to modify the plan of action once the deci­sion is made. In essence, the surgeon becomes biased in the direction of his/her rst decision. I call this, as most experienced surgeons do, the rst mistake leading to the next mistake. In other words, it is important that we as surgeons evalu­ate the cognitive xation plan and re-evaluate by “slowing down our own heart rate” and adapt intraoperatively to new conditions and situations. Early in my surgical career, during the difcult cholecystectomy with Mirrizi syndrome, I asked the resident, what she and I thought was a cystic duct. Unfortunately, it was the common bile duct adhered to the cystic duct, which I recognized immediately, as we say two open lumens, con­verted into open; spoke with the family, and did an anastomosis of the common bile duct to a limb of jejunum (choledochojejunostomy) with the assistance of one my partners. In retrospect we convinced our own bias that this is the only struc­ture going into the gallbladder.