Evidence map›Paper›PMID 39694950›Full record

ArticleSurgical endoscopy2025

Aberrant anatomy in the context of the critical view of safety.

Dimitris Papagoras, Gerasimos Douridas, Dimitrios Panagiotou, Konstantinos Toutouzas, Alexandros Charalabopoulos, Panagis Lykoudis, Dimitrios Korkolis, Dimitrios Lytras, Theodosios Papavramidis, Dimitrios Manatakis and 3 more

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Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Dimitris PapagorasSurgical Department, General Hospital of Trikala, Trikala, Greece. dpapagoras@hotmail.com.
Gerasimos DouridasSurgical Clinic, Thriasio Hospital Elefsina, Elefsina, Greece.
Dimitrios PanagiotouSurgical Department, General Hospital of Trikala, Trikala, Greece.
Konstantinos ToutouzasFirst Propedeutic Department of Surgery of the National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece.
Alexandros CharalabopoulosFirst Surgical Department of the of the National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece.
Panagis LykoudisFourth Surgical Department of the of the National and Kapodistrian University of Athens, University General Hospital Atttiko, Athens, Greece.
Dimitrios KorkolisDepartment of Surgical Oncology, Oncology Hospital Saint Savvas, Athens, Greece.
Dimitrios LytrasSecond Surgical Department General Hospital Papanikolaou, Thessaloniki, Greece.
Theodosios PapavramidisFirst Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Dimitrios ManatakisDepartment of Surgery, Naval and Veteran Hospital, Athens, Greece.
Georgios GlantzounisSurgical Department, University Hospital of Ioannina, Ioannina, Greece.
Dimitrios StefanidisDepartment of Minimal Invasive and Bariatric, Surgery University Hospital of Indianapolis, Indianapolis, USA.
Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe protective impact of the Critical View of Safety (CVS) approach on the vasculo-biliary injuries during laparoscopic cholecystectomy (LC) depends largely upon the understanding of the normal and variant anatomy. Structures exposed during the acquisition of the CVS can deviate from the typical dual configuration of the cystic duct and artery (gallbladder pedicle) representing either a third (supernumerary) or atypical in course (heterotopic) element. The aim of this study was to determine the identity and the frequency of these anatomical elements and to propose anatomic schemata that can guide the achievement of CVS by surgeons.

methodFourteen anatomic elements that can be encountered during LC were defined by members of the Hellenic task force on the typology of safe cholecystectomy using a literature review and expert consensus. Videos of 279 LCs performed for biliary colic were reviewed noting the presence of a third and or heterotopic anatomic element. In 108 LCs these elements were sought also intraoperatively. A CVS score according to Sanford and Strasberg was assigned to each video.

resultsThe normal configuration of the gallbladder pedicle was present in 233 cases (83.51%). A third element was detected in 42 cases (15.05%) and was arterial in 41 cases and biliary in 1 case. A heterotopic course concerned exclusively the cystic artery in 24 cases (8.6%). Neither of these two variant patterns compromised achievement of the CVS during LC. CVS scores improved with the addition of intraoperative assessment.

conclusionTypical and aberrant anatomy of LC was defined and anatomic schemata proposed to help the surgeon better understand aberrant anatomy and confidently and safely handle any encountered element that deviates from the normal configuration of the gallbladder pedicle during laparoscopic cholecystectomy.

Indexed as

Anatomic VariationCholecystectomy, LaparoscopicCystic DuctGallbladderFemaleHumansIntraoperative ComplicationsMalePatient SafetyAberrant anatomyAnatomical schemataCognitive knowledgeCritical view of safetyThird elementTypology

Identifiers

PMID39694950

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.