What is the critical view of safety in laparoscopic cholecystectomy and its significance in performing the procedure?
Although being a routine procedure, classical pitfalls shall be regarded, as misperception of intraoperative anatomy is one of the leading causes of bile duct injuries. The “critical view of safety” in laparoscopic cholecystectomy serves the unequivocal identification of the cystic duct before transection.
What is the critical view of safety lap chole?
The Critical View of Safety (CVS) is a method of target identification, the targets being the cystic duct and the cystic artery. Today, CVS is taught and used widely. It is accepted as a good means of identification of the cystic structures and its use is within the standard of care.
How is the critical view of safety achieved during Laparocopic cholecystectomy?
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.
What is the triangle of safety cholecystectomy?
The hepatocystic triangle is defined as the triangle formed by the cystic duct, the common hepatic duct, and inferior edge of the liver. The common bile duct and common hepatic duct do not have to be exposed. The lower one third of the gallbladder is separated from the liver to expose the cystic plate.
Who described the critical view of safety?
Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the “Critical View of Safety” (CVS) to reduce the risk of BDI.
What is the critical view?
The critical view of safety (CVS) is a method of target identification, the targets being the cystic duct and the cystic artery. Currently CVS is taught and used widely in laparoscopic surgery (3).
What is the Hepatocystic triangle?
Hepatocystic triangle (aka Calot’s triangle) is a small (potential) triangular space at the porta hepatis of surgical importance as it is dissected during cholecystectomy. Its contents, the cystic artery and cystic duct must be identified before ligation and division to avoid intraoperative injury.
What is Calot’s node?
The cystic lymph node of Lund (also known as the Calot or Mascagni node) is the sentinel node for the gallbladder, and one of the structures in Calot triangle. It lies in close proximity to the cystic artery and is one of the structures removed during cholecystectomy.
What is the normal size of gallbladder stone?
Most commonly, gallstones are 5–10 mm in diameter. Most people with gallstones do not experience any symptoms.
Where does bile go if no gallbladder?
Once the gallbladder is removed, the bile produced by the liver will flow directly into the small intestine, allowing continued digestion of fats. Until the digestive system adjusts, patients may temporarily experience more frequent and/or loose bowel movements.
What is porcelain GB?
Porcelain gallbladder refers to the condition in which the inner gallbladder wall is encrusted with calcium. The wall becomes brittle, hard, and often takes on a bluish hue. Other names for this condition are calcified gallbladder, calcifying cholecystitis, and cholecystopathia chronica calcarea.
What is sphincter of Oddi?
The sphincter of Oddi refers to the smooth muscle that surrounds the end portion of the common bile duct and pancreatic duct. This muscle relaxes during a meal to allow bile and pancreatic juice to flow into the intestine.
What is the prognosis of laparoscopic cholecystectomy?
Laparoscopic 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.
Is the “critical view of safety” superior to intraoperative cholangiography for common bile duct injury?
The “critical view of safety” is superior to intraoperative cholangiography for prevention of common bile duct injury. [abstract] Presented at the 2008 Annual Meeting of the Pacific Coast Surgical Association [Google Scholar]
Are iatrogenic bile injuries in cholecystectomy still a concern?
DISCUSSION Prevention of iatrogenic bile injuries is still a matter of significant concern, despite almost 25 years passing since the first laparoscopic cholecystectomy was performed.
What is a critical view of safety in dissection?
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.