scholarly journals The Critical View Of Safety : Une Attitude Pour Prévenir L’erreur D’identification Dans Les Cholécystectomies Laparoscopiques.

2021 ◽  
Author(s):  
Anisse Tidjane ◽  
Nabil Boudjenan-Serradj ◽  
Benali Tabeti
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Voies Biliaires ◽  
Critical View ◽  
Critical View Of Safety ◽  
Bile Duct Injuries ◽  
Bonnes Pratiques ◽  
Voie Biliaire Principale ◽  
Haptic Sensation

Résumé: Avec la généralisation de la cholécystectomie laparoscopique, l’incidence des traumatismes opératoires des voies biliaires a augmentée de façon significative. La perte de la sensation haptique, la vision bidimensionnelle, et l’éclairage centré favorisent l’illusion aboutissant à des erreurs d’identifications, où le chirurgien confond voie biliaire principale et canal cystique. Ce phénomène explique l’augmentation des traumatismes biliaires à l’ère de la laparoscopie.Récemment, et grâce aux recommandations des sociétés savantes comme la SAGES sur les bonnes pratiques chirurgicales, l’incidence de ces traumatismes est en régression et tend a rejoindre celle décrite à l’ère de la chirurgie ouverte. Parmi ses recommandations, la SAGES met l’accent sur l’adoption par tous les chirurgiens de la « Critical View of Safety » durant la réalisation de la cholécystectomie par voie laparoscopique. L’objectif de cette mise au point est de décrire cette attitude, mais surtout analyser son efficacité et ses limites dans la prévention des traumatismes opératoires des voies biliaires.Abstract:With the generalization of laparoscopic cholecystectomy, the incidence of operative bile ducts injury has increased significantly, the loss of haptic sensation, the two-dimensional vision, and the centered lighting favor the illusion leading to misidentifications, as consequences the surgeon confuses the main bile duct and the cystic duct. This phenomenon explains this increase in the incidence of bile duct injuries in the era of laparoscopy.Recently, and thanks to the recommendations of some learned societies such as SAGES on good surgical practices, the incidence of these complications is declining and tends to join that described in the era of open surgery. Among its many recommendations, SAGES recommends the adoption by all surgeons of the “Critical View of Safety” during the performance of laparoscopic cholecystectomy, an attitude that we will describe, and analyze its effectiveness and its limits in prevention of operative bile ducts injury.

The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients

HPB ◽  
2021 ◽  
Author(s):  
Petra Terho ◽  
Ville Sallinen ◽  
Hanna Lampela ◽  
Jukka Harju ◽  
Laura Koskenvuo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Evaluation Study ◽  
Critical View ◽  
Critical View Of Safety ◽  
Bile Duct Injuries

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 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 Tulžies latakų sužalojimai atliekant laparoskopinę cholecistektomiją

2007 ◽  
Vol 5 (2) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Linas Urbanavičius ◽  
Juozas Juočas ◽  
Saulius Bradulskis ◽  
Virmantas Daubaras ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
General Surgery ◽  
Bile Ducts ◽  
Diffuse Peritonitis ◽  
Clinical Hospital ◽  
Bile Duct Injuries ◽  
Extrahepatic Bile Ducts ◽  
Iatrogenic Bile Duct Injury

Donatas Venskutonis, Linas Urbanavičius, Juozas Juočas, Saulius Bradulskis, Virmantas Daubaras, Juozas KutkevičiusKauno medicinos universiteto Bendrosios chirurgijos klinika,VšĮ Kauno II klinikinė ligoninė, Josvainių g. 2, LT-47133 KaunasEl paštas: [email protected] Įvadas / tikslas Manoma, kad atliekant laparoskopinę cholecistektomiją ekstrahepatiniai tulžies latakai sužalojami dažniau nei atvirąją. Įvykus tulžies latakų sužalojimui, svarbu jį kuo skubiau diagnozuoti ir tinkamai gydyti. Siūlomos įvairios sužalojimų prevencijos priemonės. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje 1994–2006 metais laparoskopinės cholecistektomijos metu įvykusių ekstrahepatinių tulžies latakų jatrogeninių sužalojimų dažnį, priežastis, gydymo metodus, padarinius ir prevencijos priemones, apžvelgti literatūros duomenis. Ligoniai ir metodai Analizavome 1994–2006 m. KMU Bendrosios chirurgijos klinikoje (VšĮ II KKL) dėl tulžies latakų jatrogeninių sužalojimų, įvykusių laparoskopinės cholecistektomijos metu, gydytų pacientų ligos istorijas. Rezultatai Per minėtą laikotarpį atliktos 5396 laparoskopinės cholecistektomijos: 1681 (31,2%) pacientui – dėl ūminio ir 3715 (68,8%) – dėl lėtinio cholecistito. Po operacijos 7 ligoniai mirė. Vienas ligonis mirė nuo bendrojo tulžies latako sužalojimo ir pankreatito. Kitos mirties priežastys: trims ligoniams buvo plaučių arterijos embolija, vienam – dvylikapirštės žarnos perforacija ir peritonitas, dviem – gangreninis cholecistitas ir lokalus peritonitas. Bendras mirštamumas 0,13%. Ekstrahepatiniai tulžies latakai sužaloti 10 ligonių (0,19%). Vienas ligonis gydytas nuo tulžies latakų sužalojimo kitoje ligoninėje. Išvados Apibendrinus rezultatus galima tvirtinti, kad tulžies latakų sužalojimo ir mirties atvejai operuojant laparoskopiškai yra reti, o laparoskopinė cholecistektomija mūsų klinikoje – saugi operacija. Atvira cholecistektomija pranašesnė tik sunkiais, komplikuotais atvejais (neaiški anatomija, tulžies pūslės-žarnyno fistulės) ir nesant galimybės išgydyti tulžies latakų akmenligės endoskopiškai. Pagrindiniai žodžiai: cholecistitas, laparoskopinė cholecistektomija, ekstrahepatiniai tulžies latakai, sužalojimai Bile duct injuries during laparoscopic cholecystectomy donatas venskutonis, linas urbanavičius, juozas juočas, saulius bradulskis, virmantas daubaras, juozas kutkevičiusKaunas University of Medicine Clinic of General Surgery, Kaunas 2nd Clinical Hospital,Josvainių str. 2, LT-47133, Kaunas, LithuaniaE-mail: [email protected] Background / objective Laparoscopic cholecystectomy is associated with a higher risk of extrahepatic bile duct injuries. Timely diagnosis and proper management of bile duct injury are very important. Various preventive measures are widely discussed. Our aim was to analyze iatrogenic injuries of extrahepatic bile ducts sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine and to review the relevant pub-lished reports. Patients and methods Analysis of the case histories of patients treated for iatrogenic bile duct injuries sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine (2nd Clinical Hospital), Lithuania. Results During the period 1994–2006, 5396 patients underwent laparoscopic cholecystectomy for acute cholecystitis (n = 1681, 31.2%) and chronic gallstone disease (n = 3715, 68.8%). Seven patients died after surgery: one patient died of bile duct injury, 3 patients of pulmonary artery embolism; there were one case of duodenum perforation and diffuse peritonitis, one case of severe acute pancreatitis, and 2 cases of gangrenous cholecystitis with peritonitis. The overall mortality rate was 0.13%. Iatrogenic bile duct injury occurred in 10 cases (0.19%). One patient was referred from another hospital and was treated for a iatrogenic bile duct injury. Conclusions The incidence of bile duct injuries and the death rate were low. Laparoscopic cholecystectomy was performed with acceptable safety in our clinic. Conventional cholecystectomy was preferred to laparoscopic cholecystectomy in difficult, complicated cases (unclear anatomy, biliary enteric fistulas) and in cases of unsuccessful endoscopic treatment of choledocholithiasis and obstructive jaundice. Keywords: cholecystitis, laparoscopic cholecystectomy, extrahepatic bile ducts, injuries

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 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.

DAMAGE TO THE BILE DUCTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY. REVIEW.

2021 ◽  
pp. 17-25
Author(s):  
Maxat Doskhanov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Treatment And Prevention ◽  
Technical Errors ◽  
Bile Duct Injuries ◽  
Good Cosmetic

This article provides a review of the literature on bile duct injuries after laparoscopic cholecystectomy. Laparascopy is considered the gold standard in the treatment of gallstone disease. This technique has a number of positive advantages: minimally invasiveness, quick rehabilitation, a shorter hospital stay, a good cosmetic effect, and a low lethal outcome. Along with these advantages, the number of complications also increased: damage to the bile ducts, hepatic vessels, bile leakage, formation of strictures, defects in drainage of the biliary tract and improper treatment of the cystic duct, insufficient drainage of the abdominal cavity. Today, many aspects of surgical treatment and prevention of bile duct injuries remain controversial and are still considered relevant. The main reasons for this complication are: lack of experience of the surgeon, inattention, ignorance of the main options and possible anomalies of important anatomical structures in the area of the hepatic hilum and hepato-duodenal ligament, technical errors.

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