Rationale and Use of the Critical View of Safety in Laparoscopic Cholecystectomy

Strasberg, Steven M.; Brunt, L. Michael

doi:10.1016/j.jamcollsurg.2010.02.053

Cited by 438 publications

(308 citation statements)

References 11 publications

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“…Key components in minimizing ductal injury include surgeon experience, adherence to well-defined dissection principals, and cholangiography. 25,26 Routine use of cholangiography is cost-effective with maximum efficiency achieved when used by inexperienced surgeons or when complex disease is encountered. Others have argued that bile duct injury is not prevented by cholangiography, and that only meticulous dissection and correct interpretation of anatomy will avoid this complication.…”

Section: Preventionmentioning

confidence: 99%

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

2018

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Background: Laparoscopic cholecystectomy (LC), is a new modality of surgery late surfaced late 1980s. Compared with open cholecystectomy, LC is associated with less local pain, shorter hospitalization resulting in an early return to work, and a favourable cosmetic outcome. The aim of this study was to determine the incidence of major biliary injuries associated with LC.Methods: The patients have been admitted before operation and classical LC was done. Monopolar electrocautery was used. The insertion of postoperative intraperitoneal drain or nasogastric tube depended on the surgeons' preference and opinion. The data was evaluated according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose operations had to be converted from laparoscopic to open.Results: One hundred and eighty-three (183) patients were initially included in this study. LC was accomplished successfully in one hundred and sixty-two patients (162), twenty-one have been converted to the conventional open method due to sever adhesions or unclear anatomy and they were excluded from this study. Among those who underwent LC, 5(2.73%) had major biliary injuries, another 6 (3.28) had minor injuries and 7 (3.82%) Spillage of Gallstones to the Peritoneal cavity.Conclusions: Biliary injury is the Achilles’ heel of laparoscopic Cholecystectomy. It can have devastating effects, turning the individual into a "biliary cripple". They mainly result from anatomical anomalies and errors of human judgment and are thus preventable to some extent.

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Section: Preventionmentioning

confidence: 99%

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

2018

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“…Electrocautery must be used very cautiously to avoid thermal damage. If critical view of safety cannot be achieved by any reason, laparoscopic cholecystectomy should not be performed (10,12). In this situation, further approach depends on the anatomy of the patient and the preference and experience of the surgeon.…”

Section: Safe Cholecystectomy A) What Are the Essentials Of Safe Lapamentioning

confidence: 99%

Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement

Abbasoğlu¹,

Tekant²,

Alper³

et al. 2016

UCD

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Gallstone disease is very common and laparoscopic cholecystectomy is one of the most common surgical procedures all over the world. Parallel to the increase in the number of laparoscopic cholecystectomies, bile duct injuries also increased. The reported incidence of bile duct injuries ranges from 0.3% to 1.4%. Many of the bile duct injuries during laparoscopic cholecystectomy are not due to inexperience, but are the result of basic technical failures and misinterpretations. A working group of expert hepatopancreatobiliary surgeons, an endoscopist, and a specialist of forensic medicine study searched and analyzed the publications on safe cholecystectomy and biliary injuries complicating laparoscopic cholecystectomy under the organization of Turkish Hepatopancreatobiliary Surgery Association. After a series of e-mail communications and two conferences, the expert panel developed consensus statements for safe cholecystectomy, management of biliary injuries and medicolegal issues. The panel concluded that iatrogenic biliary injury is an overwhelming complication of laparoscopic cholecystectomy and an important issue in malpractice claims. Misidentification of the biliary system is the major cause of biliary injuries. To avoid this, the "critical view of safety" technique should be employed in all the cases. If biliary injury is identified intraoperatively, reconstruction should only be performed by experienced hepatobiliary surgeons. In the postoperative period, any deviation from the expected clinical course of recovery should alert the surgeon about the possibility of biliary injury.

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“…At our institution, we perform LC with regular use of ED using minilaparoscopic approach, including cauterization of the cystic artery. In a series of more than 2000 patients (Table 1) with strict adherence to the well-known principles governing safe ED [2], we have not encountered any CBD injury and not observed any objective adverse effect of ED which delayed recovery, with the vast majority of these patients being discharged within the first 24 h after their operation, and without any major complaint [3][4][5].…”

mentioning

confidence: 81%

Should high-frequency electrosurgery be discouraged during laparoscopic surgery?

2015

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Rationale and Use of the Critical View of Safety in Laparoscopic Cholecystectomy

Cited by 438 publications

References 11 publications

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement

Should high-frequency electrosurgery be discouraged during laparoscopic surgery?

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