Tu1510 Clear Anterior and Posterior View of Calot's Triangle, Display of Critical View of Safety and Demonstration of Cystic Duct-Gallbladder Junction Are Necessary to Prevent Intraoperative Cystic Duct Misidentification During Laparoscopic Cholecystectomy

Abstract Aim This report aims to evaluate the use of an AI video analytics platform in laparoscopic cholecystectomy (LC) based on the achievement of the critical view of safety (CVS) and to assess its ability to correctly comment on CVS. Method Touch surgery video platform, an AI-video based analytic tool, was screened for laparoscopic cholecystectomy in our institute and analysed from April 2019 till October 2020. Data collected by the AI included identification of the critical view of safety and time needed to achieve CVS. A reviewer graded the LC according to Nasser grading and evaluated the ability of AI to identify the CVS. Results 66 LC were included from our video database. CVS was achieved in only 56% (37/66) in all LC videos included. Mean time spent to attend CVS from start of dissection of Calot’s triangle 16.8 (±13.6) mins. 26 (39.4%) LCs were Nasser grade 2 and 20 (30.3%) each were grade 1 and grade 3. There was no significant difference between number of CVS obtained between all grades. Time spent to achieve CVS from dissecting Calot’s triangle were the longest in grade 3 LCs (28.4±17.4 mins) with significant difference between all 3 grades. Finally, the platform correctly commented on CVS in 92.4% of the all LC videos. Conclusions AI video analytics can provide a useful tool to assess laparoscopic cholecystectomies and the critical view of safety. Additionally, more studies should explore the use of the platfrom and integrate the results with the clinical outcomes.

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Optimizing the critical view of safety in laparoscopic cholecystectomy by clipping and transecting the cystic artery before the cystic duct

British Journal of Surgery ◽

10.1002/bjs.5632 ◽

2007 ◽

Vol 94 (4) ◽

pp. 473-474 ◽

Cited By ~ 10

Author(s):

A. R. Wijsmuller ◽

M. Leegwater ◽

L. Tseng ◽

H. J. Smaal ◽

G. J. Kleinrensink ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Cystic Duct ◽

Cystic Artery ◽

Critical View ◽

Critical View Of Safety

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Intraoperative strategies to overcome difficulties in laparoscopic cholecystectomy for chronic calculous cholecystitis

International Surgery Journal ◽

10.18203/2349-2902.isj20211290 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1160

Author(s):

Mohinder Singh ◽

Dipesh Goel

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Chronic Cholecystitis ◽

Critical View ◽

Critical View Of Safety ◽

Calot’S Triangle ◽

Group A ◽

Group B ◽

A Prospective Study ◽

Calculous Cholecystitis

Background: Surgery in chronic cholecystitis is very challenging because of inability to hold the gall bladder, dense adhesions, frozen Calot’s triangle and difficulty in applying clips. Precise and meticulous dissection is required to establish critical view of safety. There is no consensus among surgeons about appropriate intraoperative steps in difficult gall bladder (GB) surgery. The authors aim to present various intraoperative difficulties and strategies to overcome them. Methods: A prospective study of 81 patients of chronic cholecystitis was done in our institution. They were divided in two groups. Group A in which surgery could be done easily. Group B in which surgery was difficult and different intraoperative strategies were applied to overcome them. Results: Total 42 patients were included in group A and 39 patients in group B. Various difficulties encountered while performing laparoscopic cholecystectomy in group B were adhesions (53.8 %), inability to grasp the fundus of GB (15.3%), frozen Calot’s triangle (15.3%), inability to grasp the Hartmann’s pouch (12.8%) and cystic duct edema (2.5%). Conclusions: Intraoperative technique of identification of Rouviere′s sulcus first, followed by high peritoneal incision on the GB body. Subsequently blunt dissection of Calot’s triangle using gauze piece and hydro dissection by suction irrigation canula ventral to the sulcus. It created a retro gall bladder tunnel safely. It established the critical view of safety in all our cases.

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The rationale of critical view of safety in laparoscopic cholecystectomyA study done in Al Diwanyia teaching hospital

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1275 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Muayad Alkhafaji ◽

Ahmed Alsagban ◽

Rawya Reyadh Abbood

Keyword(s):

Bile Duct ◽

Acute Cholecystitis ◽

Teaching Hospital ◽

Cystic Duct ◽

Operating Time ◽

Chronic Cholecystitis ◽

Critical View ◽

Safe Method ◽

Critical View Of Safety ◽

Calot’S Triangle

Laparoscopic cholecystectomy (LC) has become the standard method for the removal of a diseased gallbladder. The technique most commonly employed is the infundibular approach which entails dissecting the gallbladder (GB) from its neck upward, after dissecting the cystic artery and cystic duct using laser or electrocautery. Common bile duct (CBD) injury is one of the most serious complications of LC. misidentification of the bile duct during dissection of the Calot's triangle can lead to such injuries. The critical view of safety (CVS) has been recently discussed in controlled study, it is characterized by dissection of the upper part of the Calot's space, which does not usually contain arterial or biliary anomalies so it is ideal for a safe dissection even in less experienced hands2. This study was amid to introduce a safe method for dissection of the GB away from CBD which forms one boarder in the Calot's triangle. This Prospective clinical analysis of 1000 cases of LC was utilizing the CVS technique over a period from January 2014 to January 2017 was conducted at Al-Diwanyia Teaching Hospital Laparscopic Center.The diagnosis of acute cholecystitis, chronic cholecystitis and cholilithiasis was established with history, physical examination, and ultrasound examination. The patients were categorized for sex, age, operating time and post operative There were 270 (27%) LC for (acute cholecystitis) and 730 (73%) LC for (chronic cholecystitis and cholilithiasis). There were minor significant complications when compared with CBD injuries complications, with short operating time (mean time for operation in our study35.9 minutes). Critical view of safety (CVS) seems to be a safe method of dissection that clearly demonstrating the cystic duct and help to reduce the bile duct injuries.

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Mo1456 Audit of the use of Critical View of Safety and Infundibular Cystic Technique in Cystic Duct Identification in Laparoscopic Cholecystectomy

Gastroenterology ◽

10.1016/s0016-5085(12)64150-x ◽

2012 ◽

Vol 142 (5) ◽

pp. S-1069

Author(s):

Anokha Oomman ◽

Ashraf M. Rasheed ◽

Karthic Rajaram ◽

Krithika Murugan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Cystic Duct ◽

Critical View ◽

Critical View Of Safety

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Bile Duct Injury in Laparoscopic Cholecystectomy

10.53350/pjmhs211592296 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2296-2297

Author(s):

Mariam Fatima ◽

Naeem Ghaffar ◽

Muhammad Shahid Hussain

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Gall Stone ◽

Stone Disease ◽

Critical View ◽

Critical View Of Safety ◽

Calot’S Triangle ◽

Gall Stone Disease

Background: Laparoscopic cholecystectomy is commonly performed surgical procedure for symptomatic gall stone disease due to its better cosmetic results and shorter hospital stay; however, its safety in some cases is still questionable5. Methods: A retrospective, observational study was done in surgical unit 1, Sir Ganga Ram hospital, Lahore, from January 2017 to December 2019. Results: There were 209 cases whose surgical notes, hospital record and follow up notes were studied. Among these, 21 cases were converted to open. There was no injury of bile duct in any case. Conclusion: Experience of surgeon, careful dissection at calot’s triangle, use of critical view of safety and timely decision for conversion to open were factors participating insafe surgery. Keywords: Laparoscopic Cholecystectomy, Bile duct injury, critical view of safety

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