Critical View of Safety in Laparoscopic Cholecystectomy: A Prospective, Observational Study

Abstract

Background: The critical view of safety (CVS) has been increasingly recognized as the standard method for identification of different cystic structure and to prevent any vascular or biliary injuries during laparoscopic cholecystectomy operation. Objective: To observe the percentage of patients in whom CVS was attained during laparoscopic cholecystectomy, percentage of patients where bail out procedures were needed and the type of bail out procedure adopted. Methods: This prospective, observational study was conducted in the Department of Minimal Access and General Surgery, Govt. Medical College Srinagar at Kashmir in India, over a period of 6 months. A total of 55 patients of symptomatic cholelithiasis, aged >20 years were enrolled in this study. The said patients were followed up for a period of 6 weeks in the post operative time. Results: 29(52.73%) of the patients were in the age group of 40-59 years, followed by 16(29.09%) in 20-39 years age group. Female predominance was observed as male-female ratio was 1:5. Critical view of safety (CVS) was attained in 50 patients (90.9%), while 5 patients had difficulties: difficulty in dissection of calot’s triangle in 5 cases, dense adhesions were found in 3 cases and 1 had perforated gallbladder. Significant differences were observed between two groups (CVS attained and not attained) in terms of operative time, gallbladder wall thickness and total hospital stay (p<0.001). However, no complications like bile duct injuries or mortality were observed in our study. Bail out procedures were opted – conversion to open cholecystectomy in 3 cases (60%) and laparoscopic fundus first cholecystectomy in 2 cases (40%). Conclusion: Even after adopting all these strategies of critical view of safety (CVS), the surgeons often fail to secure safety in some cases in laparoscopic cholecystectomy due to difficulty in handling gall bladder in situ.

International Journal of Human and Health Sciences Vol. 09 No. 01 Jan’25 Page: 48-52