Critical View of Safety During Laparoscopic Cholecystectomy

Abstract

The authors suggest that blunt dissection of the upper portion of Calot's space has become the preferred technique for resident training during laparoscopic cholecystectomy.

A gallbladder with the “hidden cystic duct”: A brief overview of various surgical techniques of the Calot’s triangle dissection

“…Many authors found the CVS technique to be reliable, easy to perform, and applicable in the vast majority of patients [1,2,4,6]. Furthermore, it has been found to reduce the CBD injuries even when performed by the junior surgeons with varying level of surgical skills [3,6]. This reinforces an earlier on statement that the majority of the biliary tree injuries are a consequence of the misunderstanding of an anatomy within the Calot's triangle.…”

“…The above examples make the IA an unreliable technique. On the other hand, when delivered by an experienced surgeon, it has been found to be as safe as the "critical view of safety" technique [6].…”

“…This allows for an obvious recognition of the CD and cystic artery. Many authors found the CVS technique to be reliable, easy to perform, and applicable in the vast majority of patients [1,2,4,6]. Furthermore, it has been found to reduce the CBD injuries even when performed by the junior surgeons with varying level of surgical skills [3,6].…”

Study of laparoscopic cholecystectomy in rural hospital

“…Sticking to critical view of safety approach can help in reducing misidentification of ductal and arterial anomalies in calots triangle. 7,8 Calot's triangle is bounded by common hepatic duct, cystic duct and the cystic artery and is the component of hepaticocystic triangle. 6 Accessory hepatic ducts or small bile duct may enter the gall bladder directly from its bed.…”

Value of Critical View of Safety Technique in Laparoscopic Cholecystectomy.

“…(Strasberg and Brunt ,2010). This would have prevent accidental biliary and vascular injuries due to uncommon variations, incautious bleeding control or unclear anatomy, so The patient is protected precisely because the surgeon cannot usually achieve a misleading view (Vettoretto et al, 2011). So this technique considered as the gold standard for resident teaching, because it has a lower rate of biliary and hemorrhagic complications, has a shorter operative time, builds self-confidence, and is a simple standardized method both for complicated and uncomplicated gallbladder lithiasis .…”