scholarly journals P-BN28 The Consistency of Operative Safety Markers and the Critical View of Safety During Laparoscopic Cholecystectomy: A Pilot Study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ahmad H M Nassar ◽  
Mahmoud Sallam ◽  
Rhona Kilpatrick ◽  
Kiren Ali
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pilot Study ◽  
Bile Duct ◽  
Target Identification ◽  
Consensus Conference ◽  
Critical View ◽  
Critical View Of Safety ◽  
Video Recordings ◽  
True Value ◽  
Dissection Technique

Abstract Background Safe laparoscopic cholecystectomy(LC) depends on surgeon's experience, operative difficulty, utilisation of traditional safety markers, adapting the dissection technique and, where possible, displaying the critical view of safety (CVS) to confirm cystic pedicle structures prior to division. The Safe Cholecystectomy Multi-Society Practice Guidelines and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy identified no direct comparative evidence to support the CVS over other methods of anatomic identification. The aim of this study, therefore, was to examine the consistency of safety markers guiding the dissection and to determine the value of displaying the CVS. Methods A pilot study was conducted, reviewing video recordings of 241 LCs (144 retrospective and 97 prospective). The consistency of the Rouvier Sulcus (RS), the cystic lymph node (CLN), identification of the common bile duct (CBD) and duodenum and a new marker; the “cystic duct fold” (CDF), the peritoneal fold stretching between the retracted Hartman's Pouch and the CBD guiding the dissection at its distal end over the gallbladder neck, was documented. Data on the safety marker used to commence dissection, gallbladder condition, the LC difficulty grade, the selected technique and whether the CVS was achieved was recorded and analysed. Results Although the CBD and duodenum were visualised in 77%, the CDF was identifiable in 56% (CLN in 52.3%, RS in 50.2%) and the most consistently used to commence dissection in 51.4% (CLN 17.4%, CBD in 11.6% and RS in 6.6%). 12.8% required access to the infundibulum using sub-serosal or trans-vesical dissection (41% had acute cholecystitis, empyema or gangrenous gallbladders). Infundibular dissection was used in 88%. CVS was achievable in 56.8%. The CDF dropped form 87% in difficulty grades 1 and 2 to 16.5% in grades 4 and 5 with the CLN used in 21% of these difficult LCs. Conclusions A new safety marker, the CDF is proposed, being more reliable and safer on account of starting the dissection away from the CBD and potentially aberrant ducts, contrary to the line of RS. The CLN is more reliable in difficult LC, especially with acute inflammation. Infundibular dissection remains the default approach to “target identification” required to display the CVS. The true value of the CVS, as an end product of the process of dissection, lies in “target confirmation” before dividing any structures and in clearing the cystic plate to avoid injury to Couinaud Types C, F and hepato-cystic ducts.

scholarly journals Rouviere\'s Sulcus and Critical View of Safety: A Guide to prevent Bile Duct Injury during Laparoscopic Cholecystectomy

2018 ◽  
Vol 11 (1) ◽  
pp. 25-28
Author(s):  
Tanweer Karim ◽  
Subhajeet Dey ◽  
Atul Jain ◽  
Malwinder Singh ◽  
Nabal Mishra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Critical View ◽  
Critical View Of Safety

scholarly journals The segment IV approach: a useful method for achieving the critical view of safety during laparoscopic cholecystectomy in patients with anomalous bile duct

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuichi Fujioka ◽  
Keigo Nakashima ◽  
Hiroaki Kitamura ◽  
Yuki Takano ◽  
Takeyuki Misawa ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hepatic Duct ◽  
Left Hepatic Duct ◽  
Critical View ◽  
Critical View Of Safety ◽  
Right Border ◽  
Imaginary Line ◽  
Branching Point ◽  
The Right

Abstract Background The critical view of safety (CVS) method can be achieved by avoiding vasculo-biliary injury resulting from misidentification during laparoscopic cholecystectomy (LC). Although achieving the CVS has become popular worldwide, there is no established standardized technique to achieve the CVS in patients with an anomalous bile duct (ABD). We recently reported our original approach for securing the CVS using a new landmark, the diagonal line of the segment IV of the liver (D-line). The D-line is an imaginary line that lies on the right border of the hilar plate. The cystic structure can be securely isolated along the D-line without any misidentification, regardless of the existence of an ABD. We named this approach the segment IV approach in LC. Methods In this study, we adopted the segment IV approach in patients with an ABD. Results From October 2015 to June 2020, 209 patients underwent LC using the segment IV approach. Among them, three (1.4%) were preoperatively diagnosed with an ABD. The branching point of the cystic duct was the posterior sectional duct, anterior sectional duct, or left hepatic duct in each patient. The CVS was achieved in all cases without any complications. Conclusion It is a promising technique, especially even for patients with an ABD during LC.

Operative Strategy Can Reduce the Incidence of Major Bile Duct Injury in Laparoscopic Cholecystectomy

2008 ◽  
Vol 74 (10) ◽  
pp. 985-987 ◽  
Author(s):  
Sara Yegiyants ◽  
J. Craig Collins
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Published Data ◽  
Single Institution ◽  
Operative Strategy ◽  
Critical View ◽  
Critical View Of Safety ◽  
Order Of Magnitude ◽  
Magnitude Improvement

Major bile duct injury (BDI) rates remain in the range of 0.3 to 0.5 per cent for laparoscopic cholecystectomy (LC). The dominant surgical technique worldwide continues to be the “infundibular” technique of dissection that was popularized in the early 1990s. Proponents of the “critical view of safety” (CV) technique have suggested that most of these injuries are avoidable. The objective of our study was to determine whether routine use of the CV technique reduced the observed/expected single-institution rate of major BDI over a 5-year period in a teaching hospital. All patients (n = 3042) who underwent LC for any indication at one institution over a 60-month period were identified by database search. Major BDI was identified by Common Procedural Terminology codes indicating operative repair and confirmed by review of medical records. One patient sustained a transection–excision of the common duct requiring hepaticoduodenostomy. Based on published data, the observed BDI rate was one in nine to one in 15 of the expected rate. This represents an order-of-magnitude improvement in the safety of LC at a single institution where the majority of cases were performed by residents. We suggest that the “critical view” technique should be widely adopted.

scholarly journals Colecistitis aguda en vesícula biliar izquierda. Presentación de un caso resuelto en forma segura por vía laparoscópica

2021 ◽  
Vol 113 (1) ◽  
pp. 125-130
Author(s):  
Agustín Virgili ◽  
◽  
Carlos Wendichansky ◽  
Rodrigo Maroni
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Bile Duct ◽  
Acute Cholecystitis ◽  
Preoperative Diagnosis ◽  
Direct Puncture ◽  
Critical View ◽  
Critical View Of Safety ◽  
Bile Duct Injuries ◽  
Bile Duct Anatomy

Left-sided gallbladder (LSGB) is a rare bile duct abnormality, usually found during a cholecystectomy. Symptoms usually do not differ from those of a normally positioned gallbladder, making the preoperative diagnosis extremely uncommon. We report the case of an acute cholecystitis in a patient whit LSGB, safely managed with laparoscopic surgery. A 24-year-old male patient was admitted to our institution with clinical and radiological signs of acute cholecystitis. The intraoperative finding of an acute cholecystitis in a LSGB made us modify ports positioning and a cholangiograhy was done by direct puncture of the gallbladder before hilum dissection. After the cystic duct was identified, a transcystic cholangiography was performed which confirmed a complete and clear bile duct anatomy and laparoscopic cholecystectomy was safely completed. The intraoperative finding of a LSGB makes the surgeon change some aspects of the usual technique to perform a safe cholecystectomy as LSGB significantly increases the risk of common bile duct injuries. Meticulous dissection of the gallbladder hilum to achieve a critical view of safety and the systematic use of intraoperative cholangiography are extremely important to perform a safe laparoscopic cholecystectomy.

scholarly journals Bile Duct Injury in Laparoscopic Cholecystectomy

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

Bile Duct Injury in Laparoscopic Cholecystectomy

2017 ◽  
Author(s):  
Justin Steggerda ◽  
Eric Simms ◽  
Miguel Burch
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Clinical Case ◽  
Technical Aspects ◽  
Critical View ◽  
Critical View Of Safety ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study in performance of laparoscopic cholecystectomy. Can we improve safety and reduce the risk of bile duct injury during laparoscopic cholecystectomy? Starting with that question, it provides information including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter reviews identified risk factors and describes technical aspects the authors identified to increase safety, notably defining the critical view of safety. The chapter also provides a brief critique, review of other notable studies, and concludes with a relevant clinical case regarding possible treatment of a patient with ERCP.

scholarly journals The Segment IV Approach: A Useful Method for Achieving the Critical View of Safety During Laparoscopic Cholecystectomy in Patients With Anomalous Bile Duct

2020 ◽  
Author(s):  
Shuichi Fujioka ◽  
Keigo Nakashima ◽  
Hiroaki Kitamura ◽  
Yuki Takano ◽  
Takeyuki Misawa ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hepatic Duct ◽  
Left Hepatic Duct ◽  
Critical View ◽  
Critical View Of Safety ◽  
Right Border ◽  
Imaginary Line ◽  
Branching Point ◽  
The Right

Abstract Background The critical view of safety (CVS) method can be achieved by avoiding vasculo-biliary injury resulting from misidentification during laparoscopic cholecystectomy (LC). Although achieving the CVS has become popular worldwide, there is no established standardized technique to achieve the CVS in patients with an anomalous bile duct (ABD). We recently reported our original approach for securing the CVS using a new landmark, the diagonal line of the segment IV of the liver (D-line). The D-line is an imaginary line that lies on the right border of the hilar plate. The cystic structure can be securely isolated along the D-line without any misidentification, regardless of the existence of an ABD. We named this approach the segment IV approach in LC. Methods In this study, we adopted the segment IV approach in patients with an ABD. From October 2015 to June 2020, 209 patients underwent LC using the segment IV approach. Among them, three (1.4%) were preoperatively diagnosed with an ABD. Results The branching point of the cystic duct was the posterior sectional duct, anterior sectional duct, or left hepatic duct in each patient. The CVS was achieved in all cases without any complications. Conclusion The segment IV approach is useful for achieving CVS, especially even for patients with an ABD during LC.

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