Safety Of Laparoscopic Cholecystectomy Research Articles

Scale and Safety: Analyzing the Association Between Intraoperative Difficulty and Achieving the Critical View of Safety in Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) is the preferred method for gallstone removal, but bile duct injuries remain a concern. Achieving the critical view of safety (CVS) is pivotal in preventing such injuries. The aim of this study was to compare the rates of difficult LC in those with CVS achieved compared to those with CVS not achieved. We performed a single-center prospective study on all patients with ultrasound-confirmed symptomatic gallstones. Patients were excluded if they refused to consent or if they underwent LC for indications other than gallstone disease. Patients were stratified into two groups as CVS not achieved and CVS achieved groups and compared for outcomes. Our primary outcome was the rate of intraoperative difficulty on the modified Nassar scale (MNS). Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY). We included 70 patients who underwent LC for gallstones (CVS not achieved = 24 and CVS achieved = 46). The mean (SD) age was 42.2 (12.3) years, and 73.5% were females. The mean (SD) weight in our study cohort was 74.1 (10.9) kg, and there was no difference between the two groups in terms of the baseline demographic characteristics, disease characteristics, and comorbid conditions (p > 0.05). On univariate analyses, achieving CVS was associated with lower rates of higher-grade operative difficulty on the MNS and lower rates of length of stay of more than one day. Achieving CVS is associated with easy LC based on significantly lower Nassar scores. These findings highlight the role of the MNS in the successful identification of the operative difficulty of LC and its correlation with achieving CVS.

Critical View of Safety in Laparoscopic Cholecystectomy: Can it prevent bile duct injuries. An Institutional Prospective Observational Study

Critical View of Safety in Laparoscopic Cholecystectomy: Can it prevent bile duct injuries. An Institutional Prospective Observational Study

Achievement of the Critical View of Safety in Laparoscopic Cholecystectomy & Its Outcome in MGM Medical College, Aurangabad

Achievement of the Critical View of Safety in Laparoscopic Cholecystectomy & Its Outcome in MGM Medical College, Aurangabad

Modified optical port entry site for laparoscopic cholecystectomy: Our experience.

<b><br>Introduction:</b> The four-port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of optical port entry site modification.</br> <b><br>Material and Methods:</b> To assess the feasibility and safety of laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 60 patients at Seth GSMC and KEM Hospital, India between Jan 2022 and July 2022. Our study offered the benefit of a flexible optical port entry site, using a 5 mm optical trocar instead of the conventional 10 mm trocar. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds.</br> <b><br>Results:</b> 60 cases of gallstone disease were subjected to the new technique of laparoscopic cholecystectomy over seven months. 39 cases were females and 21 were males. The age range of our patients was between 20 and 55 years with a median age of 39 years. Mean Body mass index 30 (range 25 - 37). The mean operative time was 30 min (range 15 - 45 min) and a follow-up period ranged from 10 to 14 months. No cases were converted to open. We did not encounter any untoward mishaps during surgery.</br> <b><br>Discussion:</b> Our modification of the optical port placement and size received good results and patient satisfaction. Moreover, the placement of the port at a site further from the midline and umbilicus decreases the risk of development of trocar site incisional hernia.</br&gt.

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience.

Introduction The critical view of safety is an important concept for safe laparoscopic cholecystectomy. However, no standard step-by-step approach for achieving the critical view of safety has been established until now. Therefore, this study aims to evaluate a new approach for achieving the critical view of safety using the diagonal line of liver segment IV as an anatomical landmark. Patients and methods In this prospective non-randomized study, patients (n= 112) who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis were included. The first 47 patients underwent laparoscopic cholecystectomy using the diagonal line approach (DLC group) whereas, the next 65 patients underwent laparoscopic cholecystectomy using the conventional method (CLC group). Results No significant difference between both groups regarding the preoperative characteristics, operative time, and intraoperative blood loss. Laparoscopic subtotal cholecystectomy was performed more in the DLC group (6% vs 0%, p= 0.07). Whereas, in the CLC group, there was a tendency towards conversion to open cholecystectomy in difficult cases (6% vs 2%, p= 0.40). No intra- or postoperative complications occurred in either group. Conclusion The diagonal line approach is a feasible and useful step-by-step technique to achieve the critical view of safety in laparoscopic cholecystectomy and enables surgeons to perform safe laparoscopic subtotal cholecystectomy in difficult cases.

SP11.11 Getting It Right First Time (GIRFT): An Audit of General Surgical Documentation in a District General Hospital

Abstract Aim Getting It Right the First Time (GIRFT) has released national guidance regarding operation documentation for common general surgical procedures, namely laparoscopic appendicectomy, laparotomy & laparoscopic bowel resection surgery, laparoscopic cholecystectomy and inguinal hernia repair. This audit sought to assess compliance in a single District General Hospital Surgical Department. Method Retrospective analysis of operation notes was undertaken for consecutive cases. The audit included 25 laparoscopic appendicectomy, 25 laparoscopic cholecystectomy, 10 laparoscopic inguinal hernia, 20 open inguinal hernia and 10 laparotomy/laparoscopy with bowel resection procedures. Cases were included from a range of Consultants (range: 4 for laparoscopic inguinal hernia to 9 for laparoscopic appendicectomy). Operation notes were compared to the GIRFT guidelines. Results Overall compliance was 36% for open inguinal hernia, 44% for laparoscopic cholecystectomy, 45% for laparoscopic inguinal hernia, 54% for laparoscopy/laparotomy with bowel resection and 56% for laparoscopic appendicectomy. Notable areas of poor compliance included documentation of achievement of the critical view of safety in laparoscopic cholecystectomy (28%), if the appendiceal base was healthy in appendicectomy (60%), if the ilioinguinal nerve was protected or divided (35%) or if the vas deferens/testicular vessels were protected (50%) in open inguinal hernia repair and post operative oral intake status after bowel resection (80%). Conclusions Overall there was poor compliance between the operation notes and the GIRFT guidelines. These can potentially jeopardise the position of the surgeon and Trust during medicolegal claims. Use of standardised pre-populated electronic operation notes will be introduced Department-wide and compliance re-audited.

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy.

The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC. AI software was developed to evaluate the achievement of CVS using an algorithm for image classification based on a deep convolutional neural network. Short clips of hepatocystic triangle dissection were converted from 72 LC videos, and 23,793 images were labeled for training data. The learning models were examined using metrics commonly used in machine learning. The mean values of precision, recall, F-measure, specificity, and overall accuracy for all the criteria of the best model were 0.971, 0.737, 0.832, 0.966, and 0.834, respectively. It took approximately 6fps to obtain scores for a single image. Using the AI system, we successfully evaluated the achievement of the CVS criteria using still images and videos of hepatocystic triangle dissection in LC. This encourages surgeons to be aware of CVS and is expected to improve surgical safety.

Safety of laparoscopic cholecystectomy in patients older than 90 years in a private hospital in Ecuador: a case series

Safety of laparoscopic cholecystectomy in patients older than 90 years in a private hospital in Ecuador: a case series

The Safety of Laparoscopic Cholecystectomy in Super-elderly Patients: A Propensity Score Matching Analysis.

Although reports on the safety of laparoscopic cholecystectomy (LC) exist, few have included patients aged ≥ 85 years. Hence, our study aimed to evaluate surgical outcomes of LC in patients aged ≥ 85 years. After excluding patients who underwent other types of surgeries, 583 patients who underwent LC between 2015 and 2022 were included. Patients were classified into two groups based on age: < 85 years (control group, n = 551) and ≥ 85 years (super-elderly group, n = 32). Propensity score matching (PSM) was performed based on preoperative clinical parameters, and intraoperative and postoperative outcomes were compared. After PSM, 28 patients were included in each group. Intraoperative blood loss (1 vs. 5 mL, respectively; P = .052) and frequency of serious postoperative complications (Clavien-Dindo class ≥ 2, 2/28 (7.1%) vs. 6/28 (21.4%), P = .252) were similar between the control and elderly groups. There was no significant difference in the length of postoperative stay (control group: 5 (4-24) days vs. super-elderly group: 7 (3-64) days, P = .236). Unfortunately, one case of pneumonia of unknown cause occurred postoperatively, resulting in the death of one patient in the super-elderly group. There were no clinically significant differences in the short-term outcomes of LC between super-elderly patients aged ≥ 85 years and patients aged < 85 years. Hence, LC may be relatively safe even in patients aged ≥ 85 years. However, owing to many pre-existing diseases and deterioration of physiological function, careful management during the perioperative period is desirable.

Safety of laparoscopic cholecystectomy in extremely elderly patients

Safety of laparoscopic cholecystectomy in extremely elderly patients

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity.

The management of patients with a cerebrospinal fluid (CSF) shunt located in the peritoneal cavity undergoing laparoscopic surgery is an issue that has not yet been settled. These patients are at risk of increased intracranial pressure caused by peritoneal insufflation, shunt dysfunction, and shunt infection/retrograde meningitis. This study aimed to determine the need for perioperative shunt intervention in CSF shunt patients undergoing laparoscopic cholecystectomy. We reviewed and analyzed five shunt patients who underwent laparoscopic cholecystectomy in our institution between 2012 and 2022, as well as 17 patients described in previous reports. Among the 22 patients, shunt type was ventriculoperitoneal in 14 and lumboperitoneal in eight. The most common indication for CSF shunt was hydrocephalus caused by cerebral vascular accident (50.0%). Laparoscopic cholecystectomy was performed for cholecystolithiasis in 13 patients (59.1%), acute cholecystitis in eight (36.4%), and gallbladder polyp in one (4.5%). Shunt clamping or externalization was performed in six patients. Two patients in the group that did not undergo shunt clamping or externalization experienced complications (intra abdominal abscess and subcutaneous emphysema). However, the incidence of short-term complications (both overall and shunt-related) and median length of hospital stay did not significantly differ between the two groups. Routine shunt clamping, externalization, or removal might not be necessarily required in patients with a ventriculoperitoneal or lumboperitoneal shunt undergoing laparoscopic cholecystectomy.

Comparison of the safety and effectiveness of different surgical timing for acute cholecystitis after percutaneous transhepatic gallbladder drainage: a systematic review and meta-analysis.

To compare the efficacy and safety of laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis (AC) at different time points after percutaneous transhepatic gallbladder drainage (PTGBD). PubMed, EMBASE, Cochrane Library, and Web of Science were searched from database inception to 1 May 2022. The last date of search was the May 30, 2022. The Newcastle-Ottawa scale (NOS) was used to conduct quality assessments, and RevMan (Version 5.4) was used to perform the meta-analysis. A total of 12 studies and 4379 patients were analyzed. Compared with the < 2-week group, the ≥ 2-week group had shorter operation time, less intraoperative blood loss, shorter postoperative hospital stay, lower rate of conversion to laparotomy, and fewer complications. There was no statistical difference between the two groups regarding bile duct injury, bile leakage, and total cost. The evidence indicates that the ≥ 2-week group has the advantage in less intraoperative blood loss, minor tissue damage, quick recovery, and sound healing in treating AC. It can be seen that LC after 2weeks is safe and effective for AC patients who have already undergone PTGBD and is recommended, but further confirmation is needed in a larger sample of randomized controlled studies.

Scope of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

Background: Laparoscopic cholecystectomy has become the treatment of choice for symptomatic gallstones. Previous upper abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy.This study specifically examined the effect of previous upper abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy.&#x0D; Methods: A number of 50 patients of adult age group (25 to 60 years) who were admitted suffering from gall bladder pathology and having history of previous upper abdominal surgery in the surgery units of a tertiary level hospitalwithin the time period of September, 2013 to August, 2014 were included in this prospective observational study. With the consent of the patients, laparoscopic cholecystectomy was chosen as the surgical procedure. All these data were analyzed to find out the feasibility and safety of laparoscopic cholecystectomy in the patients with previous upper abdominal surgery.&#x0D; Results: The patients were classified into 3 groups: group 1, patients with no adhesions, group 2, patients with minimum adhesions and group 3, patients with moderate dense adhesions. The 3 groups were similar with respect to age and sex (P&gt;0.05). Conversion to laparotomy was required in 5 (10%) patients (1 in group 1, 2 in group 2, and 3 in group 3). No statically significant difference was noted among groups with respect to the conversion rate (P&gt;0.05). No per-operative complications occurred in any of the groups. The post-operative complication rates among groups were not statistically different (P&gt;0.05).&#x0D; Conclusion: Previous upper abdominal surgery is not a contraindication to safe laparoscopic cholecystectomy. However, previous upper abdominal surgery is associated with an increased need for adhesiolysis, a chance for open conversion and a prolonged operation time.&#x0D; AKMMC J 2021; 12(1) : 11-15

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

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.

The artery first technique: re-examining the critical view of safety during laparoscopic cholecystectomy.

Significant discrepancies exist between surgeon-documented and actual rates of critical view of safety (CVS) achievement on retrospective review following laparoscopic cholecystectomy. This discrepancy may be due to surgeon utilisation of the artery first technique (AFT), an exception to the CVS first described by Strasberg et al. The present study aims to characterise the use of the AFT, hypothesising it is used as an adjunct in difficult dissections to maximise exposure of the hepato-cystic triangle ensuring safe cholecystectomy. Prospective digital recording of the operative procedure of patients' undergoing laparoscopic cholecystectomy were undertaken at Christchurch Public Hospital, New Zealand and North Shore Private Hospital, Sydney, Australia. Videos were uploaded to Touch Surgery™ Enterprise. Difficulty was graded, annotated and indications for the AFT quantified using a standardised protocol. A total of 275 annotated procedures were included in this study. The AFT was employed in 54 (20%) patients; in 13 (24%) patients for bleeding, in 35 (65%) patients where windows one and two were visible, and in 6 (11%) patients no windows were visible within the hepato-cystic triangle. There were significant differences in utilisation across operative grade and by seniority of operator (p < 0.005). The data presented here demonstrate the AFT is frequently used, particularly with Grade 3 cholecystectomy. However, more data are needed to confirm the utility and safety of this approach. Analysis of the AFT shows that to understand and improve safety in laparoscopic cholecystectomy appreciating how the operation was undertaken and not just that the CVS was achieved is crucial.

Rationale to achieve Critical View of Safety in Laparoscopic Cholecystectomy

Abstract not available The Journal of Ad-din Women's Medical College; Vol. 11 (1), Jan 2023; p 61-63

Assessment of routine use of critical view of safety in laparoscopic cholecystectomy, prospective cohort study

Background The reported frequency of biliary injuries has tripled to 0.4% since the advent and widespread usage of laparoscopic cholecystectomy in the 1990s. The goal of this study: in terms of practicality and safety, is to evaluate the effectiveness of a critical perspective on safety during laparoscopic cholecystectomy. Patients and Methods This prospective cohort research included 100 patients who received laparoscopic cholecystectomy between 2018 and 2021 at Assiut University Hospital and Assiut Police Hospital. Results According to the data, just one individual out of 100 suffered from bleeding, another from a bile leak, and no one suffered from liver or viscus damage. Conclusion The most secure approach to comprehend the triangle’s design is from the vital aspect of safety, and understanding so significantly aids in the prevention of ductal harm. Significant bile duct damage and accompanying complications may be avoided by employing Critical View of Safety in clinical practice.

The influence of obesity on the safety of laparoscopic cholecystectomy: a retrospective analysis

The influence of obesity on the safety of laparoscopic cholecystectomy: a retrospective analysis

Management of Cholelithiasis in Cirrhotic Patients.

Gallstone disease (GD) is a common disease worldwide and has a higher incidence in cirrhotic patients than in the general population. The main indications for cholecystectomy surgery in cirrhotic patients remain symptomatic cholelithiasis and its complications. Over the past two decades, numerous published reports have attested to the feasibility and safety of laparoscopic cholecystectomy in cirrhotic patients. Surgery in patients with liver cirrhosis represents an additional source of stress for an already impaired liver function and perioperative complications are remarkably high compared to non-cirrhotic patients, despite significant advances in surgical management. Therefore, preoperative risk stratification and adequate patient selection are mandatory to minimize postoperative complications. We have conducted a systematic review of the literature over the last 22 years for specific information on indications for surgery in cirrhotic patients and individual percentages of Child-Pugh grades undergoing treatment. There are very few reported cases of cholecystectomy and minimally invasive treatment, such as percutaneous transhepatic cholecystostomy (PTC), in patients with Child-Pugh grade C cirrhosis. With this work, we would like to pay attention to the treatment of cholelithiasis in cirrhotic patients who are still able to undergo cholecystectomy, thus also encouraging this type of intervention in cases of asymptomatic cholelithiasis in patients with Child-Pugh grades A and B.

HPB P47 Management of acalculous cholecystitis: Experiences from a district general hospital

Abstract Background Acalculous cholecystitis (AC) is a serious inflammatory condition of the gallbladder with associated high morbidity and mortality. Definitive management of AC involves cholecystectomy and/or cholecystostomy in combination with antibiotic therapy. Due to the lack of consensus regarding the optimal management of AC leading to possible variability in clinical practice, this study aims to review the management of AC in this busy district general hospital. Methods Data were collected retrospectively on consecutive patients with diagnosis of cholecystitis from March 2018 to March 2020. The data was analysed and patients with confirmed gallstones on imaging and no clinical/radiological signs of cholecystitis were excluded. In this two-year study period, a total of 61 patients were treated for AC. Results Twenty-eight patients were managed conservatively with antibiotics (median age of 68 and median ASA of 2). Thirty-three patients were offered definitive management; cholecystostomy (2 inpatients), laparoscopic cholecystectomy (9 inpatients and 13 elective patients), 5 remain on the waiting list for surgery and 4 declined surgery. Among patients who were offered definitive management, the median age was 62 and median ASA was 2. Seven patients developed complications of AC; 2 patients underwent acute laparoscopic cholecystectomy, 2 patients were offered elective laparoscopic cholecystectomy after having a cholecystostomy, 1 patient underwent cholecystostomy, 1 patient was offered elective laparoscopic cholecystectomy after antibiotic treatment and 1 patient was treated with antibiotics alone. 30-day readmission rate was similar between patients with conservative management (5 patients) and definitive management (4 patients). Conclusions With similar re-admission rates, this small study suggests that definitive management options may not be superior to antimicrobial therapy alone and demonstrates that management can be tailored according to clinical needs. A larger prospective study is recommended to fully assess the efficacy and safety of laparoscopic cholecystectomy, cholecystostomy and antibiotic therapy in managing AC.