The clinical importance of the critical view of safety in laparoscopic cholecystectomy

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Injury of the bile duct during cholecystectomy (CHE) is a severe complication. The critical view of safety (CVS) can help to reduce the frequency of this complication during laparoscopic CHE. So far, no scoring of CVS images with a grading system is available. The CVS images of 534 patients with laparoscopic CHE could be structurally analyzed and assessed with marks from 1(very good) to 5(insufficient). The CVS mark was correlated with the perioperative course. Additionally, the perioperative course of patients after laparoscopic CHE with and without aCVS image was investigated. In 534 patients 1or more CVS images could be analyzed. The average CVS mark was 1.9, whereby 280 patients (52.4%) had a1, 126 patients (23.6%) a2, 114 (21.3%) a3 and 14 patients (2.6%) a4 or5. Younger patients with elective laparoscopic CHE had CVS images significantly more frequently (p ≤ 0.04). The statistical examination with Pearson's χ2-test and the F‑test (ANOVA) showed asignificant correlation between improving CVS marks and reduction of surgery time (p < 0.01) and the hospitalization time (p < 0.01). For senior physicians the quota of CVS images ranged from 71% to 92% and the average marks from 1.5 to 2.2. The marks for the CVS images were significantly better for female than male patients (1.8 vs. 2.1, p < 0.01). There was a relatively broad distribution of marks for CVS images. Injuries of the bile duct can be avoided with a high degree of certainty with marks 1‑2 for the CVS image. The CVS is not always adequately visualized in laparoscopic CHE.