Transillumination of Calot’s Triangle on Laparoscopic Cholecystectomy: A Feasible Approach to Achieve a Critical View of Safety

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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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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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

Gastroenterology ◽

10.1016/s0016-5085(13)64158-x ◽

2013 ◽

Vol 144 (5) ◽

pp. S-1115

Author(s):

Chris Brown ◽

Rami Radwan ◽

Ashraf M. Rasheed

Keyword(s):

Laparoscopic Cholecystectomy ◽

Cystic Duct ◽

Posterior View ◽

Critical View ◽

Critical View Of Safety ◽

Calot’S Triangle

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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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