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

Abstract

Background Laparoscopic cholecystectomy is currently one of the most commonly performed procedures globally. Morbidity of laparoscopic cholecystectomy is low; however, bile duct injury is still a feared complication. Despite worldwide efforts, the global incidence of bile duct injury remains higher for laparoscopic cholecystectomy compared with open cholecystectomy. Despite the general belief that the learning curve and lack of laparoscopic skills represent the most common causes of bile duct injuries, the principal cause is the misidentification of biliary anatomy. The aim of our study is to determine if laparoscopic transillumination is a feasible approach to bile and vascular structures visualization during laparoscopic cholecystectomy because the only other method for real-time visualization is fluorescent cholangiography, which can be cost-prohibitive and requires specialized equipment and training.

Analysis of risk factors for complications after laparoscopic cholecystectomy

“…It is difficult to accurately find the cystic duct and cystic artery during operation, which is easy to damage the right hepatic artery and cause abdominal hemorrhage. In severe cases, right hepatic ischemia can occur [ [11] , [12] , [13] ]. The thickening of the gallbladder wall indicates the presence of inflammation in the gallbladder, and the more obvious the thickening of the gallbladder wall indicates the more serious the congestion and edema of the gallbladder wall.…”

Analysis of risk factors for bile duct injury in laparoscopic cholecystectomy in China: A systematic review and meta-analysis

“…In addition, the anatomic variations of the gallbladder triangle were recognized as a risk factor for LC-related bile duct injury. [ 19 , 20 ] Approximately 70% to 80% of iatrogenic bile duct injuries occur because of the incorrect identification of biliary tract anatomical structure, [ 21 ] and anatomic variations render it difficult to distinguish between the cystic duct, the common hepatic duct, and the common bile duct. Bile duct variations are diverse, with the parallel or spiral confluence of the cystic duct and the common hepatic duct being the most common cause of bile duct injury.…”