Critical View Of Safety Technique Research Articles

CVS: An Effective Strategy to Prevent Bile Duct Injury

Background: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). These are accompanied by major morbidity and mortality. Studies have shown varying degrees of success in the reduction of bile duct injury (BDI) using the Critical View of Safety (CVS) technique. The aim of this study was to see the efficacy of the CVS technique as the sole method of dissection in laparoscopic cholecystectomy. Methods: 1647 cases of LC were done between January 2012 and January 2022 for a period of 10 years in two hospitals. All were operated by the CVS dissection technique and none by the infundibular technique. Cases included acute cholecystitis, chronic cholecystitis, gangrenous cholecystitis, empyema, and Gallbladder (GB) polyp. Results: The average operating time was 42 minutes and the range was 13 to 80 minutes. In 92% of cases, all 3 criteria of CVS were achieved. In the remaining 8% cases were either converted to open or operated by a division of GB or subtotal cholecystectomy was done. There was only one case of cystic duct stump leak requiring drainage and common bile duct stenting. Conclusion: The excellent outcome of our study suggests that the CVS method will be the gold standard technique in the dissection of the gallbladder in LC. Further dissemination of the technique is necessary to improve safety in LC.

Adoption of Critical View of Safety versus Infundibular Technique in Laparoscopic Cholecystectomy: A comparative study

Background: Laparoscopic cholecystectomy (LC) is the most common elective surgery performed by a general surgeon. Although being a routine procedure, classical pitfalls as misperception of intraoperative anatomy is one of the leading causes of bile duct injuries (BDI). The critical view of safety (CVS) in LC can be a new safe technique for identification of anatomy to reduce such a risk. Objective: To assess the efficacy of CVS in LC compared with the traditional infundibular technique. Methods: This comparative study included 344 patients who suffered from symptomatic gall stones. Patients have been grouped into two groups: group A (172 patients) operated utilizing the traditional infundibular technique and group B (172 patients) by CVS technique. Preoperative patient assessment, operating time and intraoperative and postoperative events including hospital stay, were recorded. Those patients who were unfit and or with bleeding disorders were excluded from the study. Postoperatively, patients were assessed using clinical examination for the possible complications. Results: The main perioperative complications bleeding and bile leak were significantly reported in infundibular group 6.98% and 9.88% respectively compared to 0.58% and 1.74% in CVS group respectively. Postoperatively, both intra-abdominal collection and bile leak were significantly lower in CVS group (1.16% and 1.74%, respectively) than in infundibular group (7.58% and 6.98%, respectively). Furthermore, hospital stay was significantly less in CVS group (1.8±2.7 days) compared to infundibular group (3.14±2.8 days). Conclusion: Using the CVS is associated with shorter operative time, less frequent peri- and postoperative complications and shorter hospital stay compared with infundibular technique. Keywords: Laparoscopic cholecystectomy, critical view of safety (CVS) Citation: Abdulhassan BA, Noman ZK, Hamdawi MA. Adoption of critical view of safety versus infundibular technique in laparoscopic cholecystectomy: A comparative study. Iraqi JMS. 2022; 20(2): 262-268. doi: 10.22578/IJMS.20.2.14

Comparative Study of Critical View of Safety vs Infundibular Technique in Laparoscopic Cholecystectomy

OBJECTIVES: The purpose of this study is to compare the critical view of safety technique with the infundibular technique in laparoscopic cholecystectomy in terms of mean operative time and bile duct injuries (BDI). METHODOLOGY: Between 2018 and 2020, 220 patients had laparoscopic cholecystectomy in the Surgical "A" unit at Hayatabad Medical Complex in Peshawar, Pakistan. The patients were divided into two groups, with the first receiving a critical view of safety and the second receiving an infundibular procedure. Operation time and bile duct injury were compared between the two groups. RESULTS: The operative time was significantly reduced with the critical view of safety (CVS) approach, with a mean time of 35.07 minutes for CVS and 40.58 minutes for infundibular technique, with a significant P-value (0.013).  About 17 (7.7%) cases required open cholecystectomy; the conversion rate was higher in the infundibular group, with a significant P-value (<0.001). CONCLUSION: Although the "critical view of safety" requires more patience during dissections than the infundibular approach, it is proven to be faster and is considered a safe procedure in laparoscopic cholecystectomy. KEYWORDS: Critical View of Safety (CVS), Infundibular Technique (IT), Bile Duct Injury (BDI)

Verification of Use of the Critical View of Safety Technique during Laparoscopic Cholecystectomy in a Rural Hospital: A Retrospectivse Study

Verification of Use of the Critical View of Safety Technique during Laparoscopic Cholecystectomy in a Rural Hospital: A Retrospectivse Study

The effect of various surgical techniques in difficult cholecystectomy: A retrospective cohort study

Background: Success of laparoscopic cholecystectomy depends on multiple factors.Knowledge about altered anatomy, physiology and pathology of gall bladder, and thesurgeons experience in applying different surgical technique during difficult cholecystectomyare collectively important for a safe outcome.Methods: A total data of 875 patients who underwent cholecystectomy were analysed from June 2014 to May 2019. Study was mainly focused on looking for various intraoperative findings that could be the reason for conversion to open cholecystectomy in patients with difficult anatomy, physiology and pathology associated gall stone disease.Results: about 279/875 (31.9%) had difficult gall bladder with altered anatomy and pathology. Overall, conversion rate among difficult laparoscopic cholecystectomy was 62/279 (22.2%). 36/875 (2.4%) patients undergone subtotal cholecystectomy. 1/875 (0.1%)had common bile duct injury underwent repair. 54/875 (61.7%) had developed overall complications and 1/875 (0.1%) died due sepsis.Conclusion: High conversion rate and complications are seen in patients with contracted gallbladder and adhesions due to previous intervention. Conversion from laparoscopic cholecystectomy to open cholecystectomy is not a complication but continuum of treatment to reduce morbidity. Use of the critical view of safety technique very useful.

Critical view of safety and Rouviere's sulcus

Introduction Bile duct injury is a serious complication of cholecystectomy. To fulfill the criteria for a critical view of safety requires Calot's triangle to be cleared free of fat and fibrous tissue. Rouviere's sulcus is a 2–5-cm sulcus running to the right of the liver hilum anterior to the caudate lobe. Aim Our aim is to study critical view of safety and Rouviere's sulcus as extrahepatic landmarks and their benefits in avoiding common bile duct injury. Patients and methods From January 2015 to December 2018 (35 months), in New Damietta University Hospital, 300 patients with calculous cholecystitis undergoing laparoscopic cholecystectomy were included in this study. Results Rouviere's sulcus was present in 293 (97.7%) patients: open type was found in 175 (58.3%) patients, whereas closed type was found in 118 (39.3%) of patients. The sulcus was not present in seven (2.3%) of patients. A critical view of safety was inspected in all patients (100%). There was conversion to open cholecystectomy in two (0.7%) patients owing to severe adhesions which cannot be dissected laparoscopically. No mortality was recorded in the follow-up period. Conclusion Rouviere's sulcus and critical view of safety technique are very helpful extrahepatic landmarks to avoid common bile duct injury and perform safe laparoscopic cholecystectomy.

Lacunar implementation of the critical view of safety technique for laparoscopic cholecystectomy. results of a nationwide survey

Lacunar implementation of the critical view of safety technique for laparoscopic cholecystectomy. results of a nationwide survey

The rationale of critical view of safety in laparoscopic cholecystectomyA study done in Al Diwanyia teaching hospital

Laparoscopic cholecystectomy (LC) has become the standard method for the removal of a diseased gallbladder. The technique most commonly employed is the infundibular approach which entails dissecting the gallbladder (GB) from its neck upward, after dissecting the cystic artery and cystic duct using laser or electrocautery. Common bile duct (CBD) injury is one of the most serious complications of LC. misidentification of the bile duct during dissection of the Calot's triangle can lead to such injuries. The critical view of safety (CVS) has been recently discussed in controlled study, it is characterized by dissection of the upper part of the Calot's space, which does not usually contain arterial or biliary anomalies so it is ideal for a safe dissection even in less experienced hands2. This study was amid to introduce a safe method for dissection of the GB away from CBD which forms one boarder in the Calot's triangle. This Prospective clinical analysis of 1000 cases of LC was utilizing the CVS technique over a period from January 2014 to January 2017 was conducted at Al-Diwanyia Teaching Hospital Laparscopic Center.The diagnosis of acute cholecystitis, chronic cholecystitis and cholilithiasis was established with history, physical examination, and ultrasound examination. The patients were categorized for sex, age, operating time and post operative There were 270 (27%) LC for (acute cholecystitis) and 730 (73%) LC for (chronic cholecystitis and cholilithiasis). There were minor significant complications when compared with CBD injuries complications, with short operating time (mean time for operation in our study35.9 minutes). Critical view of safety (CVS) seems to be a safe method of dissection that clearly demonstrating the cystic duct and help to reduce the bile duct injuries.
  

Lacunar implementation of the critical view of safety technique for laparoscopic cholecystectomy: Results of a nationwide survey

BackgroundBile duct injury remains a dilemma in laparoscopic cholecystectomy, with an incidence still higher than in conventional cholecystectomy. The Critical View of Safety technique is used as one of the important operating technique to reduce bile duct injury incidence. The objective of this study was to determine current practices in laparoscopic cholecystectomy and the use of the Critical View of Safety technique among surgeons and residents in surgical training. MethodsWe conducted an electronic survey among all affiliated members of the Association of Surgeons of the Netherlands containing questions regarding the current practice of laparoscopic cholecystectomy, essential steps of the Critical View of Safety technique, reasons for conversion to open cholecystectomy, and the use of other safety techniques. ResultsThe response rate was 37% (766/2,055). In the study, 610 completed surveys were analyzed. Of the respondents, 410 (67.2%) were surgeons and 200 (32.8%) were residents in surgical training. Furthermore, 98.2% of the respondents indicated incorporating the Critical View of Safety technique into current practice. However, only 72% of respondents performed the essential steps of the Critical View of Safety technique frequently. Subsequently, half of respondents were able to identify the corresponding steps of the Critical View of Safety technique, and only 16.9% were able to distinguish these adequately from possible harmful steps. Furthermore, 74.9% selected ≥1 possible harmful steps as part of this technique. Residents significantly performed and selected the essential steps of the Critical View of Safety technique more often than surgeons. Intraoperative cholangiography, intraoperative ultrasound, and fluorescence cholangiography are seldom used. Bail-out techniques such as subtotal cholecystectomy, fundus first dissection, and leaving the gallbladder in situ are familiar to the majority of respondents. ConclusionResponses indicate that practically all Dutch surgeons and residents claim to use the Critical View of Safety technique. The majority of surgeons and residents are unable to discern correctly the essential steps of the Critical View of Safety technique from actions not part of the technique and even potentially harmful. Residents' current knowledge regarding the Critical View of Safety technique is superior to those of surgeons.

Critical view of safety faster and safer technique during laparoscopic cholecystectomy?

Objective:Incidence of Bile Duct Injuries (BDI) during Laparoscopic Cholecystectomy (LC) is reported to be higher as compared to Open Cholecystectomy. Studies have shown varying degree of success in reducing BDI by using Critical View of Safety (CVS) technique before clipping and cutting any structure. In this study, we will see whether CVS technique is faster and safer compared to conventional infundibular technique.Methods:This comparative study was conducted on patients who presented to Surgical Out-Patient-Department (OPD) of Khyber Teaching Hospital from July 2015 to June 2016. Total of 438 patients were divided into two groups. Group-A in which LC was done using infundibular while in Group-B, CVS technique was utilized. Two groups were compared for operating time and BDI.Results:The operative time was significantly reduced for LC using CVS technique (50 mins vs. 73 mins). Minor leaks were comparable (0.5% vs. 0.9%) but there was a significant difference in major LEAKS between the two techniques (0.5% vs. 1.4%).Conclusion:Although the “critical view of safety” requires more dissection as compared to infundibular technique, but once learnt and mastered, it is faster and safer identification technique during laparoscopic cholecystectomy.

Importance of critical view of safety in laparoscopic cholecystectomy: a survey of 120 serial patients, with no incidence of complications.

Backgrounds/AimsTo determine the importance of critical view of safety techniques in laparoscopic cholecystectomy.MethodsA total of 120 patients were included in the study, between January 2015 to March 2016. Hydrodissection was performed for cases presenting with severe adhesions or cholecystitis. A critical view of safety was performed for all patients undergoing the procedure for isolation of cystic duct and cystic artery with cystic plate dissection. Demographic characteristics of the patients, as well as intraoperative and postoperative minor or major complications were recorded.ResultsA total of 81 (67.5%) female and 39 (32.5%) male patients succesfully underwent surgeries following the critical view of safety and hydrodissection technique. Acute/chronic cholecystitis, or severe adhesions in the surgical field, were detected in 34 (28.3%) patients. There were no intraoperative or postoperative biliary complications. Wound infection was detected in 5 (4.1%) patients. All patients were discharged on either the first, second or third postoperative day.ConclusionsBiliary duct injury during laparoscopic cholecystectomy is an important complication. In this study, we show that the critical view of safety and hydrodissection techniquesminimizes the bile duct injury during laparoscopic cholecystectomy, including in difficult cases.

CRITICAL VIEW OF SAFETY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has become the preferred choice of management for gallstone disease. In spite of various theories explored trying to assess different aspects of management and outcome to reach the acceptable safest technique in laparoscopic operation and to compare it with its counterpart. Many surgical methods were attempted to clarify their value in counteracting a serious complication of laparoscopic cholecystectomy, mainly is the bile duct injury. This study aimed to evaluate the significance of critical view of safety as a technique of laparoscopic cholecystectomy concerning the issue of preventing bile duct injury in regard to the infundibular technique of dissection. This is an observational study of two hundred fifty patients who were scheduled for laparoscopic cholecystectomy using critical view of safety technique compared with probably matched previously performed two hundred fifty of laparoscopic cholecystectomy using infundibular technique. The incidence of bile duct injury was analyzed in both groups. The results shows that age, sex, body mass index and gall bladder status were comparable in both groups. The Incidence of bile duct injury in infundibular technique was (1.6%), while in critical view of safety technique the incidence was 0% which is statistically significant (P

Teaching and learning the critical view of safety technique in laparoscopic cholecystectomy

Teaching and learning the critical view of safety technique in laparoscopic cholecystectomy

Insufficient safety measures reported in operation notes of complicated laparoscopic cholecystectomies

In 2007, a Dutch guideline for laparoscopic cholecystectomy (LC) was composed that advocates the critical view of safety (CVS) to prevent bile duct injury (BDI). Conversion to open cholecystectomy is recommended in complicated cholecystectomy, but young surgeons are hardly trained in this procedure. The aim of this study was to analyze the accuracy of dictated operation notes, the use of CVS before and after guideline implementation, and the severity of injury after conversion. Between 1990 and 2012, 800 patients were referred for treatment of BDI. All available operation notes (n = 528; 66%) were scored for procedural conditions, reasons for conversion, the use of safety measures, and postoperative care in BDI patients. Patient demographics, indication for cholecystectomy, conversion rates, and injury type were comparable to the total cohort of BDI patients. LC (n = 479; 91%) was converted in 180 patients (34%). The CVS technique or dissection of Calot's triangle were reported in 33 patients (6.3%) and 87 patients (16.5%), respectively. Guideline implementation increased the reporting of CVS from 4% (16/425) to 17% (17/103; P < .001), and the consultation of a hepatic-pancreatic-biliary (HPB) colleague from 3% (14/425) to 8% (8/103; P < .01). Conversion to open surgery leads to more complex injury (Bismuth III-V injury rate of 34% [24/64] vs 65% [46/116]; P = .013). The insufficient use of safety measures to prevent BDI during LC in this selected patient group is of concern. Although guideline implementation significantly improved the use of CVS during LC, further improvement is necessary. Conversion cannot simply be used as an "escape" procedure, because this may lead to more complex injury.