Advertisement

The critical view of safety in laparoscopic cholecystectomy is optimized by exposing the inner layer of the subserosal layer

  • 845 Accesses

  • 21 Citations

Abstract

During laparoscopic cholecystectomy (LC), misidentification of the cystic duct, which causes major bile duct injuries, can result from wrong or incomplete dissection of Calot’s triangle. Therefore, the critical view of safety has been accepted as a safe method for gaining a sufficient view of Calot’s triangle before transecting the cystic duct. However, even in cases without aberrant anatomy of the bile duct, bile duct injury can occur by a wrong approach to a critical view of safety. Additionally, in cases of badly inflamed gallbladders, it is often hard to achieve a critical view of safety, because Calot’s triangle is often solid and cannot be expanded. In our standardized procedure, which is based on exposing the inner layer of the subserosal layer (the ss-i layer), the critical view of safety can be safely achieved. We have safely performed LC, using our standardized procedure, for many cases with cholecystitis with highly inflamed gallbladders. In this article, focusing especially on prevention of bile duct injuries, we present our standardized procedure to achieve the critical view of safety along with histological findings.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006;93:158–68.

  2. 2.

    Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180:101–25.

  3. 3.

    Strasberg SM. Avoidance of biliary injury during laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg. 2002;9:543–7.

  4. 4.

    Honda G, Iwanaga T, Kurata M. Dissection of the gallbladder from the liver bed during laparoscopic cholecystectomy for acute or subacute cholecystitis. J Hepatobiliary pancreat Surg. 2008;15:293–6.

  5. 5.

    Strasberg SM. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg. 2008;15:284–92.

  6. 6.

    Wijsmuller AR, Leegwater M, Tseng L, Smaal HJ, Kleinrensink GJ, Lange JF. Optimizing the critical view of safety in laparoscopic cholecystectomy by clipping and transecting the cystic artery before the cystic duct. Br J Surg. 2007;94:473–4.

  7. 7.

    Kanhere HA, Bridgewater FH. Re: optimizing the critical view of safety in laparoscopic cholecystectomy by clipping and transecting the cystic artery before the cystic duct. Br J Surg. 2007;94: 913–4; author reply 914.

Download references

Author information

Correspondence to Goro Honda.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Honda, G., Iwanaga, T., Kurata, M. et al. The critical view of safety in laparoscopic cholecystectomy is optimized by exposing the inner layer of the subserosal layer. J Hepatobiliary Pancreat Surg 16, 445–449 (2009). https://doi.org/10.1007/s00534-009-0060-3

Download citation

Keywords

  • Critical view of safety
  • Laparoscopic cholecystectomy
  • Subserosal layer
  • Rouviére’s sulcus