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A safe laparoscopic cholecystectomy depends upon the establishment of a critical view of safety

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Abstract

Bile duct injuries (BDI) during a laparoscopic cholecystectomy (LC) occur more frequently than during an open cholecystectomy. Many expert surgeons learn to perform procedures safely based on their experience. Above all, the critical view of safety (CVS) introduced by Strasberg in 1995 is the standard practice to prevent BDI during an LC. The CVS is achieved by clearing all fat and fibrous tissue in Calot’s triangle, after which the cystic structures can be clearly identified, occluded, and divided. Failure to successfully create this view may be an indication for conversion to an open cholecystectomy. The Japan Society for Endoscopic Surgery (JSES) introduced an accreditation examination in 2004. The critical view is an important factor used to judge a safe dissection. The annual ratios of successful applicants were 63% in 2004, 45% in 2005, 36% in 2006, 39% in 2007, and 44% in 2008. Biennial questionnaire surveys by JSES show that the laparoscopic BDI rates were 0.66% in 1990–2001, 0.79% in 2002, 0.77% in 2003, 0.66% in 2004, 0.77% in 2005, 0.65% in 2006, and 0.58% in 2007. Therefore, 2007 was the first year in which the rate was below 0.6%. A decreasing BDI rate is therefore expected because successful candidates will introduce technical improvements to colleagues in their hospitals and local regions.

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References

  1. Roslyn JJ, Pinns GS, Hughes GS, Saunders-Kirkwood K, Zinner MJ, Cates JA. Open cholecystectomy: A contemporary analysis of 42,474 patients. Ann Surg 1993;218:129–137.

    Article  CAS  PubMed  Google Scholar 

  2. McLean TR. Risk management from litigation involving laparoscopic cholecystectomy. Arch Surg 2006;141:643–648.

    Article  PubMed  Google Scholar 

  3. Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in Medicare beneficiaries. JAMA 2003;290:2168–2173.

    Article  CAS  PubMed  Google Scholar 

  4. Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: A prospective nation-wide series. J Am Coll Surg 1997;184:571–579.

    CAS  PubMed  Google Scholar 

  5. Moore MJ, Bennett CL. The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg 1995;170:55–57.

    Article  CAS  PubMed  Google Scholar 

  6. Yamashita Y, Kurohiji T, Kakegawa T. Evaluation of two training programs for laparoscopic cholecystectomy: incidence of major complications. World J Surg 1994;18:279–285.

    Article  CAS  PubMed  Google Scholar 

  7. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101–125.

    CAS  PubMed  Google Scholar 

  8. Bismuth H. Postoperative strictures of the bile duct. In: Blumgart LH, editor. The biliary tract. Edinburgh: Churchill Livingstone; 1982. p. 209–218.

    Google Scholar 

  9. Keulemans TC, Bergman JJ, de Wit LT, Rauws EA, Huibregtse K, Tytgat DN, et al. Improvement in the management of bile duct injuries? J Am Coll Surg 1998;187:246–254.

    Article  CAS  PubMed  Google Scholar 

  10. Schmidt SC, Settmacher U, Langrehr JM, Neuhaus P. Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery 2004;135:613–618.

    Article  PubMed  Google Scholar 

  11. Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 2006;93:158–168.

    Article  CAS  PubMed  Google Scholar 

  12. Calley MP. Avoiding biliary injury during laparoscopic cholecystectomy: technical considerations. Surg Endosc 2006;20:1654–1658.

    Article  Google Scholar 

  13. Hugh TB. Laparoscopic bile duct injury: some myths (review, see comment, 21 references). ANZ J Surg 2002;72:164–167.

    Article  PubMed  Google Scholar 

  14. Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P, et al. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 1997;184:571–578.

    CAS  PubMed  Google Scholar 

  15. Murr MM, Giot JF, Nagorney DM, Amsen WS, Ilstrup DM, Famell MB, et al. Long-term results of biliary reconstruction after laparoscopic bile duct injuries. Arch Surg 1999;134:604–609.

    Article  CAS  PubMed  Google Scholar 

  16. Doganay M, Kama NA, Reis E, Kologlu M, Atli M, Gozalan U, et al. Management of main bile duct injuries that occur during laparoscopic cholecystectomy. Surg Endosc 2002;16:216.

    Article  CAS  PubMed  Google Scholar 

  17. Gazzania GM, Filauro M, Mori L. Surgical treatment of iatrogenic lesions of the proximal common bile duct. World J Surg 2001;25:1254–1259.

    Article  Google Scholar 

  18. Mercado MA, Chan C, Orozco H, Tielve M, Hinojosa CA. Acute bile duct injury: the need for a high repair. Surg Endosc 2003;17:1351–1355.

    Article  CAS  PubMed  Google Scholar 

  19. Sikora SS, Kumar A, Das NR, Sarkari A, Saxena R, Kapoor VK, et al. Laparoscopic bile duct injuries: spectrum at tertiary care center. J Laparoendosc Adv Surg Tech A 2001;11:63–68.

    Article  CAS  PubMed  Google Scholar 

  20. Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 1994;167:35–39.

    Article  CAS  PubMed  Google Scholar 

  21. Brodsky A, matter I, Sabo E, Cohen A, Abrahamson J, Eldar S. Laparoscopic cholecystectomy for acute cholecystitis: Can the need for conversion and the probability of complications be predicted? Surg Endosc 2000;14:755–760.

    Article  CAS  PubMed  Google Scholar 

  22. Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 2001;15:965–968.

    Article  CAS  PubMed  Google Scholar 

  23. Barkum JS, Barkum AN, Meakins JL. Laparoscopic versus open cholecystectomy: the Canadian experience. Am J Surg 1993;165:455–458.

    Article  Google Scholar 

  24. Sanabria JR, Gallanger S, Croxford R, Strasberg SM. Risk factors in laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg 1994;179:696–704.

    CAS  PubMed  Google Scholar 

  25. Hugh TB. New strategies to prevent laparoscopic bile duct injury:- surgeons can learn from pilots. Surgery 2002;132:826–835.

    Article  PubMed  Google Scholar 

  26. Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003;237:460–469.

    Article  PubMed  Google Scholar 

  27. Wauben LSG, Goossens RHM, van Eijk DJ, Lange JF. Evaluation of protocol uniformity concerning laparoscopic cholecystectomy in the Netherlands. World J Surg 2008;32:613–620.

    Article  PubMed  Google Scholar 

  28. Michalowski K, Borman PC, Krige JEJ, Gallagher PJ, Terblanche J. Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 1998;85:904–906.

    Article  CAS  PubMed  Google Scholar 

  29. Beldi G, Glattli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis. A follow-up study. Surg Endosc 2003;17:1437–1439.

    Article  CAS  PubMed  Google Scholar 

  30. Tian Y, Wu SD, Su Y, Kong J, Yu H, Fan Y. Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: Experience of a hospital in northern china. Surg Today 2009;39:510–513.

    Article  PubMed  Google Scholar 

  31. Way LW. Bile duct injury during laparoscopic cholecystectomy. Ann Surg 1992;215:195.

    Article  CAS  PubMed  Google Scholar 

  32. Hunter JG. Exposure, dissection, and laser versus electrosurgery laparoscopic cholecystectomy. Am J Surg 1993;165:492–496.

    Article  CAS  PubMed  Google Scholar 

  33. Asbun HJ, Rossi RL, Lowell JA, Munson JL. Bile duct injury during laparoscopic cholecystectomy: mechanism of injury, prevention, and management. World J Surg 1993;17:547–552.

    Article  CAS  PubMed  Google Scholar 

  34. Woods MS, Traverso LW, Kozarek RA, Tsao J, Rossi RL, Gough D, et al. Characteristics biliary tract complications during laparoscopic cholecystectomy: a multi-institutional study. Am J Surg 1994;167:27–34.

    Article  CAS  PubMed  Google Scholar 

  35. Fletcher DR. Biliary injury at laparoscopic cholecystectomy: recognition and prevention. ANZ J Surg 1993;63:673–677.

    Article  CAS  Google Scholar 

  36. Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ. Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 1999;229:449–457.

    Article  CAS  PubMed  Google Scholar 

  37. Ludwig K, Bernhardt J, Steffen H, Lorenz D. Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 2002;16:1098–1104.

    Article  CAS  PubMed  Google Scholar 

  38. Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 2003;289:1639–1644.

    Article  PubMed  Google Scholar 

  39. Woods MS, Traverso LW, Kozarek RA, Donohue JH, Fletcher DR, Hunter JG. Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc 1995;9:1076–1080.

    Article  CAS  PubMed  Google Scholar 

  40. Kullman E, Borch K, Lindstrom E, Svanvik J, Anderberg B. Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy. Br J Surg 1996;83:171–175.

    Article  CAS  PubMed  Google Scholar 

  41. Carroll BJ, Friedman RL, Liberman MA, Phillips EH. Routine cholangiography reduces sequelae of common bile duct injuries. Surg Endosc 1996;10:1194–1197.

    Article  CAS  PubMed  Google Scholar 

  42. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg 1997;84:695.

    Article  CAS  PubMed  Google Scholar 

  43. Nakajima J, Sasaki A, Obuchi T, Baba S, Nitta H, Wakabayashi G. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today 2009;39:870–875.

    Article  PubMed  Google Scholar 

  44. Richardson MC, Bell G, Fullarton GM. Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. West of Scotland laparoscopic cholecystectomy audit group. Br J Surg 1996;83:1356–1360.

    Article  CAS  PubMed  Google Scholar 

  45. Japan Society for Endoscopic Surgery. 9th nationwide survey of endoscopic surgery in Japan (in Japanese). Nihon Naisikyougeka Gakkaikaizashi (J Japan Society for Endoscopic Surgery) 2008;14:503–515.

    Google Scholar 

  46. Takada T (editor). Guidelines for the management of acute cholangitis and cholecystitis (in Japanese). Tokyo: Igakutosho; 2005.

    Google Scholar 

  47. Takada T, Nimura Y, Kawaharada Y, Hirata K, Yasuda H, Yamashita Y, et al. Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg 2007;14:1–121.

    Article  PubMed  Google Scholar 

  48. Strasberg SM. Biliary injury in laparoscopic surgery. Part 2. Changing the culture of cholecystectomy. J Am Coll Surg 2005;20:604–611.

    Article  Google Scholar 

  49. Yegiyants S, Collins JC. Operative strategy can reduce the incidence of major bile duct injury on laparoscopic cholecystectomy. Am Surg 2008;74:985–987.

    PubMed  Google Scholar 

  50. Vazquez RM. Common sense and common bile duct injury: common bile duct injury revisited. Surg Endosc 2008;22:1743–1745.

    Article  PubMed  Google Scholar 

  51. Avgerinos C, Kelgiorgi D, Touloumis Z, Baltazi L, Dervenis C. One thousand laparoscopic cholecystectomies in a single surgical unit using the “critical view of safety” Technique. J Gastrointest Surg 2009;13:498–503.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan

    Yuichi Yamashita

  2. Fujinomiya City General Hospital, Shizuoka, Japan

    Taizo Kimura

  3. Department of Surgery, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan

    Sumio Matsumoto

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  1. Yuichi Yamashita
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  2. Taizo Kimura
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  3. Sumio Matsumoto
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Yamashita, Y., Kimura, T. & Matsumoto, S. A safe laparoscopic cholecystectomy depends upon the establishment of a critical view of safety. Surg Today 40, 507–513 (2010). https://doi.org/10.1007/s00595-009-4218-z

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  • DOI: https://doi.org/10.1007/s00595-009-4218-z

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