ArticleJSLS : Journal of the Society of Laparoendoscopic Surgeons
Critical view of safety during laparoscopic cholecystectomy.
Article in JSLS : Journal of the Society of Laparoendoscopic Surgeons. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
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Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it, 104 citations in OpenAlex.
- Critical view of safety approach vs. infundibular technique in laparoscopic cholecystectomy, which one is safer? A systematic review and meta-analysis.Updates in surgery · 2025Pooled it
- Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy.Surgical endoscopy · 2020Guideline
- The Best Approach for Laparoscopic Fluorescence Cholangiography: Overview of the Literature and Optimization of Dose and Dosing Time.Surgical innovation · 2017Trial
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- Fluorescence Cholangiography for Extrahepatic Bile Duct Visualization in Urgent Mild and Moderate Acute Cholecystitis Patients Undergoing Laparoscopic Cholecystectomy: A Prospective Pilot Study.Journal of clinical medicine · 2025Article
- Rare anatomical variants encountered during laparoscopic cholecystectomy in low resource conditions and the convenient concept of the safe zone of dissection: a prospective observational study at a single center.Journal of minimally invasive surgery · 2024Article
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- A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety.Surgical endoscopy · 2024Article
- Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial.Journal of clinical medicine · 2024Article
- Comparing a novel wide field of view laparoscope with conventional laparoscope while performing laparoscopic cholecystectomy.Surgical endoscopy · 2023Article
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- Defining Critical View of Safety During Laparoscopic Cholecystectomy: The Preoperative Predictors of Failure.Cureus · 2023Article
- Determinants, Costs, and Consequences of Common Bile Duct Injury Requiring Operative Repair Among Privately Insured Individuals in the United States, 2003-2020.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2023Article
- Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis.World journal of clinical cases · 2022Review
- [Remnant gallbladder cholecystitis, an increasingly common entity: Case report].Revista medica del Instituto Mexicano del Seguro Social · 2022Article
- Critical view of robotic-assisted transverse abdominal release (r-TAR).Hernia : the journal of hernias and abdominal wall surgery · 2021Article
- Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure.Surgical endoscopy · 2021Article
- Comparative analysis of reliability and clinical effects of the critical view of safety approach used in laparoscopic cholecystectomy in the pediatric population.Pediatric surgery international · 2021Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesLaparoscopic cholecystectomy has a 0.3% to 0.5% morbidity rate due to major biliary injuries. The majority of surgeons have routinely performed the so-called "infundibular" technique for gallbladder hilar dissection since the introduction of laparoscopy in the early nineties. The "critical view of safety" approach has only been recently discussed in controlled studies. It is characterized by a blunt dissection of the upper part of Calot's space, which does not usually contain arterial or biliary anomalies and is therefore ideal for a safe dissection, even in less experienced hands. MATERIALS AND
methodsWe applied and compared the critical view of safety triangle approach with the infundibular approach in a retrospective cohort study. We divided 174 patients into 2 groups, with a similar case-mix (cholelithiasis, chronic cholecystitis, and acute cholecystitis). Results of operations performed by a young surgeon using critical view of safety dissection were compared to results of the infundibular approach performed by an experienced surgeon. Outcome values and operative times were examined with univariate analysis (Student t test).
resultsNo difference occurred in terms of morbidity (even though comparison for biliary injuries is inconclusive because of insufficient power) and outcome; significant differences were found in operative time, favoring the critical view of safety approach in every stage of gallbladder disease, with minor significance for acute cases.
conclusionWe suggest this technique as the gold standard for resident teaching, because it has a similar rate of biliary and hemorrhagic complications but has a shorter operative time, builds self-confidence, and is a simple standardized method both for complicated and uncomplicated gallbladder lithiasis.
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