The Rationale of Critical View of Safety in laparoscopic cholecystectomy. A study done in Al-Diwanyia Teaching Hospital

Abstract

Laparoscopic cholecystectomy (LC) has become the standard method for the removal of a diseased gallbladder. The technique most commonly employed is the infundibular approach which entails dissecting the gallbladder (GB) from it's neck upward, after dissecting the cystic artery and cystic duct using laser or electrocautery. Common bile duct (CBD) injury is one of the most serious complications of LC. Misidentification of the bile duct during dissection of the Calot's triangle can lead to such injuries.
The critical view of safety (CVS) has been recently discussed in controlled study, it is characterized by dissection of the upper part of the Calot's space, which does not usually contain arterial or biliary anomalies so it is ideal for a safe dissection even in less experienced hands.

Aim of study :
To introduce a safe method for dissection of the GB away from CBD which forms one boarder in the Calot's triangle
Patients and methods
Prospective clinical analysis of 1000 cases of LC utilizing the CVS technique over a period from January 2014 to January 2017 was conducted at Al-Diwanyia Teaching Hospital Laparscopic Center.
The diagnosis of acute cholecystitis, chronic cholecystitis and cholilithiasis was established with history, physical examination, and ultrasound examination.
The patients were categorized for sex ,age, operating time and post-operative complications.
There were 270 (27 %) LC for (acute cholecystitis) and 730 (73 %) LC for (chronic cholecystitis and cholilithiasis).
Results
There were minor significant complications when compared with CBD injuries complications with short operating time (mean time for operation in our study 35.9 minutes).
Conclusion
Critical view of safety (CVS) seems to be a safe method of dissection that clearly demonstrating the cystic duct and help to reduce the bile duct injuries.