ArticleSurgical endoscopy2021
Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure.
Article in Surgical endoscopy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers.
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Who cites it
43 citing papers in PubMed, 70 citations in OpenAlex.
- Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): an international multicentre randomized controlled trial.Surgical endoscopy · 2023Trial
- Artificial Intelligence for Automated Recognition of Hepatocystic Anatomy During Laparoscopic Cholecystectomy: Current Evidence, Clinical Readiness, and Future Directions.Medicina (Kaunas, Lithuania) · 2026Review
- Fundus-first dissection: a salvage technique for the difficult laparoscopic cholecystectomy.Surgical endoscopy · 2026Article
- Prevention of bile duct injury - A bird's eye view.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026Review
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- Development, application and evaluation of an artificial intelligence (AI)-based platform (SurgSmart) for the automatic assessment of the critical view of safety (CVS) in laparoscopic cholecystectomy (LC).Surgical endoscopy · 2026Article
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- Efficacy of laparoscopic bailout surgery for moderate and severe acute cholecystitis.Scientific reports · 2025Article
- Acute cholecystitis: a new technique to use carefully.World journal of emergency surgery : WJES · 2025Article
- Anticipating critical view of safety challenges in laparoscopic cholecystectomy for symptomatic cholelithiasis patients: Can we predict them earlier?Turkish journal of surgery · 2025Article
- Anatomical Challenges in Laparoscopic Cholecystectomy: Five Arterial Branches from a Right Hepatic Caterpillar Hump.The American journal of case reports · 2025Article
- Omental patch as prevention for bile leak in patients undergoing subtotal cholecystectomy: a propensity score analysis.Updates in surgery · 2025Article
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- Acute cholecystitis and subtotal cholecystectomy.World journal of emergency surgery : WJES · 2025Article
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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
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- The Rationale of sub-hepatic drainage on a specialist biliary unit: a review of 6140 elective and urgent laparoscopic cholecystectomies and bile duct explorations.Langenbeck's archives of surgery · 2024Article
- Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study.Surgical endoscopy · 2024Observational
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBile duct injury rates for laparoscopic cholecystectomy (LC) remain higher than during open cholecystectomy. The "culture of safety" concept is based on demonstrating the critical view of safety (CVS) and/or correctly interpreting intraoperative cholangiography (IOC). However, the CVS may not always be achievable due to difficult anatomy or pathology. Safety may be enhanced if surgeons assess difficulties objectively, recognise instances where a CVS is unachievable and be familiar with recovery strategies. AIMS AND
methodsA prospective study was conducted to evaluate the achievability of the CVS during all consecutive LC performed over four years. The primary aim was to study the association between the inability to obtain the CVS and an objective measure of operative difficulty. The secondary aim was to identify preoperative and operative predictors indicating the use of alternate strategies to complete the operation safely.
resultsThe study included 1060 consecutive LC. The median age was 53 years, male to female ratio was 1:2.1 and 54.9% were emergency admissions. CVS was obtained in 84.2%, the majority being difficulty grade I or II (70.7%). Displaying the CVS failed in 167 LC (15.8%): including 55.6% of all difficulty grade IV LC and 92.3% of difficulty grade V. There were no biliary injuries or conversions.
conclusionAll three components of the critical view of safety could not be demonstrated in one out of 6 consecutive laparoscopic cholecystectomies. Preoperative factors and operative difficulty grading can predict cases where the CVS may not be achievable. Adapting instrument selection and alternate dissection strategies would then need to be considered.
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