Ann Hepatobiliary Pancreat Surg.  2017 Feb;21(1):17-20. 10.14701/ahbps.2017.21.1.17.

Importance of critical view of safety in laparoscopic cholecystectomy: a survey of 120 serial patients, with no incidence of complications

• Kaya B
• Fersahoglu MM
• Kilic F
• Onur E
• Memisoglu

• KMID: 2371563
• DOI: http://doi.org/10.14701/ahbps.2017.21.1.17

Abstract

BACKGROUNDS/AIMS
To determine the importance of critical view of safety techniques in laparoscopic cholecystectomy.
METHODS
A total of 120 patients were included in the study, between January 2015 to March 2016. Hydrodissection was performed for cases presenting with severe adhesions or cholecystitis. A critical view of safety was performed for all patients undergoing the procedure for isolation of cystic duct and cystic artery with cystic plate dissection. Demographic characteristics of the patients, as well as intraoperative and postoperative minor or major complications were recorded.
RESULTS
A total of 81 (67.5%) female and 39 (32.5%) male patients succesfully underwent surgeries following the critical view of safety and hydrodissection technique. Acute/chronic cholecystitis, or severe adhesions in the surgical field, were detected in 34 (28.3%) patients. There were no intraoperative or postoperative biliary complications. Wound infection was detected in 5 (4.1%) patients. All patients were discharged on either the first, second or third postoperative day.
CONCLUSIONS
Biliary duct injury during laparoscopic cholecystectomy is an important complication. In this study, we show that the critical view of safety and hydrodissection techniquesminimizes the bile duct injury during laparoscopic cholecystectomy, including in difficult cases.

Keyword

Laparoscopic cholecystectomy; Biliary duct injury; Critical view of safety

MeSH Terms

Arteries
Bile Ducts
Cholecystectomy, Laparoscopic*
Cholecystitis
Cystic Duct
Female
Humans
Incidence*
Male
Wound Infection

Figure

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  Fig. 1 The hydrodissection technique was performed in difficult cholecystectomy cases. The Hartman pouch (black arrow) of the gallbladder was seriously adhered to the duodenum (white arrow).

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  Fig. 2 The cystic duct and cystic artery were isolated. Critical view of safety was obtained.

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  Fig. 3 Saline solution (0.9%) was given to Hartman pouch.

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  Fig. 4 The tissues became eudomatous after isotonic instillation. The common bile duct (white arrow) was easily separeted from the Hartman pouch of gallbladder (black arrow) with hydrodissection.

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  Fig. 5 Cystic duct (black arrow) and common bile duct (white arrow) are clearly isolated after hydrodissection. Critical view of safety was obtained.

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