Technique Of Laparoscopic Cholecystectomy Research Articles

Critical view of safety approach vs. infundibular technique in laparoscopic cholecystectomy, which one is safer? A systematic review and meta-analysis.

Laparoscopic cholecystectomy (LC) remains the gold standard procedure for the management of benign gallbladder disease. Recognizing the need to mitigate complications, mainly bile duct injury(BDI), various techniques for ductal identification during LC have emerged, including the "Critical View of Safety" (CVS) and the infundibular technique (IT). In this systematic review and meta-analysis, we assess and compare the outcomes of both techniques, with a primary focus on evaluating their impact on BDIs. A comprehensive search was conducted using PubMed and Scopus databases. The search focused on the surgical technique, incidences of minor and major BDIs, operative time, conversion rate, and length of stay, among patients undergoing LC for benign gallbladder disease. Our initial search retrieved 264 studies. After screening the unique studies against our predefined inclusion/exclusion criteria, only five met our criteria and were included. Additionally, a manual search identified eight more relevant studies, bringing the total number of included studies to 13. The total number of included patients was 4,837. Approximately two-thirds underwent LC using the CVS approach (61.1%), and 66.3% were female, with a mean age of 44.4 ± 11.2 years. The CVS approach was associated with a significant reduction in overall BDIs (RR = 0.36; 95% CI 0.18-0.71) and major BDIs (RR = 0.28; 95% CI 0.13-0.63). However, there were no significant differences in terms of minor BDIs, operative time, conversion rates, or length of stay. Our study demonstrated the superiority of the CVS approach in terms of reducing the incidence of overall and major BDIs compared to IT. However, our study revealed no other significant differences between the two techniques. Further research, including multicentric randomized controlled trials, will be necessary to further evaluate the efficacy of these techniques.

Laparoscopic cholecystectomy in a patient with Kartagener syndrome having multiple cystic arteries: a case report

Introduction and importance: Situs inversus totalis (SIT) is a rare condition that involves transposition of thoracic and abdominal viscera. It is associated with Kartagener syndrome (KS) that comprises a triad of SIT, bronchiectasis, and chronic sinusitis. Considering this anatomical variation, it poses a technical challenge for right-handed surgeons performing laparoscopic cholecystectomy. This is the only case report for a patient having KS presenting for cholelithiasis found to have multiple cystic arteries during surgery. Case presentation: A 55-year-old man with KS, known to have bronchiectasis, presented with nonspecific diffuse upper abdominal pain and positive murphy sign on the left. Biliary colic with cholelithiasis was diagnosed using ultrasound of the abdomen. The patient was admitted to the surgical floor for persistent biliary colic and was planned for laparoscopic cholecystectomy. The cholecystectomy was done by a single right-handed surgeon, and the patient was discharged on the next day. Clinical discussion: The American laparoscopic cholecystectomy technique with reversed mirror-image of routine laparoscopic cholecystectomy port sites was adopted. The operative team including the operating surgeon and camera operator were on the patient’s right side, and the laparoscopic devices with the technician nurse were located on the left side for safer dissection and easier access to the different structures. The procedure was complicated by the Calot triangle anatomy variation along with the presence of three cystic arteries and one cystic duct. The surgery was completed within 50 minutes, a shorter duration compared to other reported cases. Conclusion: Laparoscopic cholecystectomy in patients with SIT is a challenging, technically demanding procedure due to anatomical inversion and structural variations. The surgeon must modify various technical steps to perform this procedure successfully and dissect the gallbladder and its structures. A good knowledge of anatomy and a skillful dissection intraoperatively remain the gold standards for a successful outcome with minimal complications.

Systematic Review of Utilized Ports in Laparoscopic Cholecystectomy: Pushing the Boundaries.

Surgical procedures have undergone a paradigm shift in the last 3 decades, with minimally invasive surgery becoming standard of care for a number of surgeries, including the treatment of benign gallbladder diseases. By providing a thorough and impartial summary of the earlier published systematic reviews, the current systematic review is the first to present comparison results. This review illustrates the data of intraoperative and postoperative results of each laparoscopic cholecystectomy technique. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. A newly developed extraction table was utilized to obtain the predefined parameters from eligible systematic reviews, including operative time, conversion rate, estimated blood loss, bile leak, length of hospital stay, postoperative pain, and cosmetic results. All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software, version 26.0. The analysis of dichotomous results was summarized using relative risks and 95% confidence intervals (95% CI), and continuous results were summarized using mean differences and 95% CIs. The proportions were compared using a single proportion z-test. The analysis of our primary and secondary outcomes revealed a statistically significant improvement in aesthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Patients should be carefully selected for SILC to minimize technical difficulties and prevent complications both intraoperatively and shortly after the procedure. This trial is registered with CRD42023392037.

Single-Incision Laparoscopic Cholecystectomy Using a Set of Novel Needle Instruments.

Although the technique of single-incision laparoscopic cholecystectomy (SILC) has improved remarkably, problems such as limited exposure and instrument collision persist. We describe a new SILC technique that uses a set of specially-designed needle instruments. Fifty-six patients with benign gallbladder disease underwent SILC using the newly-designed needle assembly instruments (NAIs). The NAIs comprise an needle assembly exposing hook for operative field exposure and an needle assembly electrocoagulation hook for dissection. During the operation, the NAIs were assembled and disassembled before and after gallbladder removal within the abdominal cavity. The operative efficacy and postoperative complications of this procedure were evaluated. SILC was completed successfully in 52 cases, and four cases (7.14%) required an additional trocar. There were no conversions to open surgery. The mean operative time was 48.2 ± 21.8min, and the mean operative bleeding volume was 10.5 ± 12.5mL. Minor postoperative complications occurred in 3 cases, including 2 cases of localized fluid accumulation in the abdominal cavity and 1 case of pulmonary infection, and all of them recovered after conservative treatment. There was no occurrence of bile leak, abdominal bleeding, bile duct injury and incisional hernia. The medical cost of each case was saved by approximately $200. The abdominal scars produced by the needle instruments were negligible. NAIs can make SILC safer, more convenient, and less expensive.

Clinical application of magnetic anchor technique in laparoscopic cholecystectomy: the first retrospective study in China.

Magnetic anchor technique (MAT) is frequently used in laparoscopic cholecystectomy. However, there are few reports on its clinical application in China. In this study, we retrospectively analyzed the clinical application of MAT in laparoscopic cholecystectomy in China. 25 patients (4 males, 21 females) who underwent laparoscopic cholecystectomy assisted by MAT at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled from November 2020 to March 2021. Their records were retrospectively analyzed. The magnetic anchor device was independently designed and developed by the authors and consisted of the anchor magnet and magnetic grasping apparatus. Surgical time, intraoperative blood loss, intraoperative accidents, operator experience, postoperative incision pain score, postoperative complications, and other indicators were evaluated and analyzed. All patients successfully underwent laparoscopic cholecystectomy, including 3 cases of MAT-assisted transumbilical single-port LC, 16 cases of MAT-assisted 2-port LC and 6 cases of conventional 3-port LC. The median operation time was 50 min (range 30-95 min); intraoperative bleeding was less than 30 ml. The median score of surgical incision on day 1 and 3 after the operation was 3 (range 1-4) and 1 (range 1-3), respectively. All patients had no intraoperative bile duct injury, vascular injury, postoperative bleeding, bile leakage, biliary stricture and other complications. No adverse events (such as injury to adjacent organs or failure of the magnetic anchor device) occurred either during or after the operation. The MAT-assisted laparoscopic cholecystectomy appears to be safe, feasible and effective and exhibits unique assistance in transumbilical single-port laparoscopic cholecystectomy.

Safe laparoscopic cholecystectomy technique and timing for acute cholecystitis: a study in India

Background: Acute cholecystitis patients undergo laparoscopic cholecystectomy (LC) within 72 hours or 6 weeks to 12 weeks after onset is widely considered the optimal timings for LC. However, there has been no clear consensus about it. We aimed to determine safe technique of LC for acute cholecystitis within 72 hours or any time of presentation with no delay in surgery. Methods: Medical records of 100 patients who underwent standard LC were reviewed retrospectively. Patients were divided into group 1, patients undergoing LC within 72 hours of onset; group 2, between 4 days to 14 days; group3, between 3 weeks to 6 weeks; group 4, more than 6 weeks. Results: No significant differences existed between groups in conversion rate to open surgery, operation time, blood loss, or postoperative morbidity, and hospital stay. However, total hospital stays in groups 1 and 2 was significantly shorter than that in groups 3 and 4 (p<0.01). In addition, the total hospital stay in group 3 was also significantly shorter than that in group 4 (p<0.01). Conclusions: Best timing of LC for acute cholecystitis may be within 72 hours, and there is no need to delay LC in patients presenting after 72 hours and with safe technique of dissecting at infundibulum retrieval of stones and cystic duct stump closure with catgut loop there is no significant difference observed retrospectively.

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.

Prospects for the introduction of simulation training in the educational process for the training of future surgical doctors

Annotation. The relevance of the issue concerning the exploration of prospects for implementing simulation-based learning into the educational process for training future surgeons is driven by the contemporary demand for alternative communicative approaches, effective tools, methods, and enriching traditional medical education with modern teaching technologies. The article analyses the effectiveness of using simulation equipment in virtual surgery and the feasibility of integrating simulation technologies into medical educational programs for preparing future surgeons, using the example of the simulation training center at V.N. Karazin Kharkiv National University. The appropriateness of utilizing the Lap Mentor technique for mastering practical surgical skills in 6th-year students during the “Cholecystectomy” training module is assessed through the practice of laparoscopic cholecystectomy technique in the university's simulation center. Comparing the research results reveals that students in the experimental group, who employed simulation methodologies to acquire practical and theoretical skills, had a relatively higher percentage of mastery of essential knowledge in the chosen subject. The results described in the article once again emphasize the advantages of using simulation-based learning in medical education practice while preparing highly skilled surgical professionals. This is due to the development of professional competencies and the acquisition of clinical experience during independent operations, which occur without harm to the patient and without subjecting the learner to stressful factors. The prospects for further developments lie in integrating simulation-based learning into the training process for the fundamentals of laparoscopic surgery, which has become a necessary condition and an integral part of ensuring the effectiveness of practical training for future surgeon physicians.

Comparison between Open Cholecystectomy, 4-Port Laparoscopic Cholecystectomy and One-Port Laparoscopic Cholecystectomy: A Literature Review

Cholecystectomy is the most commonly performed surgical procedure to treat gallbladder disease. In recent decades, the technique of laparoscopic cholecystectomy has been developed, which has proven to be a less invasive alternative with better results compared to traditional open cholecystectomy. However, laparoscopic one-port cholecystectomy has recently been introduced as an even less invasive variant. In this literature review article, a comprehensive comparison is made between open cholecystectomy, 4-port laparoscopic cholecystectomy and one-port laparoscopic cholecystectomy, evaluating the epidemiology, clinical significance, definition, surgical technique, advantages and complications of each approach.

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Abstract Background Adequate perioperative analgesia in laparoscopic cholecystectomy (LC) is important for improving patient outcomes. The subcostal transversus abdominis plane (STAP) block and the thoracic paravertebral block (PVB) are types of regional anesthesia that have been used for postoperative analgesia in upper abdominal surgery. Aim The aim was to compare the analgesic efficiency and safety of STAP block versus PVB for postoperative analgesia in LC. Patients and methods This randomized double-blind study was done on 90 patients, of both sexes, from 18 to 65 years old, with American Society of Anesthesiologists I and II, and scheduled for elective LC. Patients were randomized into three equal groups (n=30): group I received general anesthesia (GA) only, group II received GA and preoperative bilateral ultrasound (US)-guided STAP block, and group III received GA and preoperative bilateral US-guided PVB at T7. Results Heart rate, mean arterial blood pressure, and visual analog scale during rest and during cough showed insignificant differences at 30 min, 12, 18, and 24 h after recovery but were significantly lower at 2, 4, and 6 h in STAP and PVB groups compared with the GA group. Meanwhile, there were insignificant differences between STAP and PVB groups during the whole postoperative period. Moreover, the first request of pethidine was significantly longer and the amount of intraoperative fentanyl and postoperative pethidine were significantly lower in STAP and PVB groups than in the GA group. Conclusion Bilateral US-guided STAP block and bilateral US-guided PVB are effective and safe analgesic techniques for LC, but pneumothorax should be considered while performing PVB.

Two Port and Two Suture Modified Laparoscopic Cholecystectomy Technique

Two Port and Two Suture Modified Laparoscopic Cholecystectomy Technique

Indocyanine green direct injection into gallbladder during laparoscopic cholecystectomy: a safety method to outline biliary anatomy

Background One of the most frequently done operations in digestive surgery is the laparoscopic cholecystectomy (LC). Despite several safety precautions and guidelines, iatrogenic bile duct damage (BDI) during LC still occurs at a very high incidence. Fluorescence of biliary system may minimise surgical difficulties that might emerge owing to unintended harm to the common bile duct. Methods We outline a technique for directly injecting Indocyanine Green (ICG) into the gallbladder to clarify the architecture of the cystic duct and common bile duct. Fifty patients who underwent elective laparoscopic cholecystectomy participated in the study, which was a randomised controlled clinical trial. Patients who had intraoperative direct injection of ICG into the gallbladder were chosen at random using closed envelope technique, then using near-infrared fluorescence (NIF) imaging during LC) and controls (who underwent standard LC technique) Twenty five patients in each limb. Patients were studied pre-operative, intraoperative & postoperative. 50 patients in all, 25 of whom received LC with intracholecystic ICG injection, and 25 of whom underwent standard LC without the use of ICG, were included in our study. Results ICG dye was successful to delineate extrahepatic biliary anatomy well in 20 cases out of 25, while without ICG, 9 cases out of 25 were without clear delineation of common bile duct intraoperative even if cystic duct was clear enough to avoid complications in both groups . Operative Time average in cases with ICG-assisted LC was 78±15.0 min which was less than the average of time consumed in LC without ICG to dissect cystic duct and visualize critical view of safety, 101±11.87 min Conclusion Direct gallbladder ICG infusion enables quick extrahepatic biliary system imaging and clarifies the dissection, increasing protection against BDI and reducing intraoperative dissection time.

The technique of laparoscopic and robotic extended cholecystectomy for gallbladder cancer

The application of minimally invasive surgery for gallbladder cancer (GBC) is yet controversial. This article discusses the techniques of laparoscopic and robotic extended cholecystectomy. A 69-year-old male diagnosed with cT1-2N0 GBC underwent laparoscopic surgery, and a 55-year-old male with cT2N1 GBC underwent robotic surgery after preoperative chemotherapy. Nonanatomical partial hepatectomy with lymphadenectomy was performed. Liver parenchymal dissection was performed using Cavitron Ultrasonic Surgical Aspirator laparoscopically and Maryland bipolar dissector and Harmonic scalpel robotically. The operation time was 180 and 220 minutes, and the estimated blood loss was 140 and 130 mL, respectively. The final pathologies were pT1bN0 and pT2aN1, for which patients received adjuvant chemotherapy. There was no evidence of recurrence at 33 and 18 months without complications. Both laparoscopic and robotic extended cholecystectomy can be safely performed with the robotic surgical system as an effective alternative for GBC requiring liver resection with radical lymphadenectomy.

Evolution of Cholecystectomy-Gall Bladder must be Removed not because it Contains Stones but Forms them

Normally, human bile contains enough chemicals to dissolve the cholesterol excreted by our liver. But if our liver excretes more cholesterol than the bile can dissolve, the excess cholesterol, too much bilirubin, or not enough bile salts, first form into crystals and eventually turn into stones when stored in the gall bladder. The estimated overall prevalence of cholelithiasis is 10–15% in the general population, with some differences across countries, ethnic and age groups. The good fact is most of the gall stone patients are asymptomatic. The prevalence of gall stones is around 6% of the total population in India, with a clear predominance among females with 10% and 3% in men. In India among 808 million adult population 81 million will suffer Cholelithiasis every year and a conservative 1.6 million (2%) of them would need surgery. Among American adults the prevalence of cholelithiasis is about 10% while in Western Europe the prevalence ranges from 5.9% to 21.9%. More than one million Americans are diagnosed with gallstones every year, joining about 38 million who already have the disorder. Cholecystectomy: the surgical resection and removal was and continues to be the permanent solution and the gold standard for the definitive management of symptomatic cholelithiasis. J. L. W Thudichum proposed a two-stage elective cholecystostomy in 1859, In the first stage, the inflamed gall bladder was sewed to the anterior abdominal wall through a small incision, to serve as a route for the removal of gall stone later in the second stage. Laparoscopic cholecystectomy (LC) since its inception in 1989 has become the gold standard treatment for gall stone disease. The technique of performing LC has undergone many changes and variations. Several surgeons have tried to reduce the size and number of ports to improve cosmetic and postoperative outcomes and developed their own different versions. The most recent development in technique of LC is single incision laparoscopic surgery (SILS) or single site laparoscopic cholecystectomy (SSLC). This review is a consequence of witnessing an elective Cholecystectomy and review of the prevailing cost across the country and health insurance coverage in India. As a public health problem Cholelithiasis can’t be prevented, and Cholecystectomy is needed to 1.6 million Indian adults each year costing a fortune. Currently it cannot be accessed by all, especially the poor and even lower middle socio-economic class. With overall, health insurance coverage of around 30%, that too among urbanites, mainly covered by employers in India is a public health challenge. Ayushman Bharat a national initiative launched on 23rd September 2018, a GOI health assurance initiative adapted by almost all State governments for providing accessible and affordable healthcare to the common man for secondary and tertiary care hospitalization is still in a nascent stage. Methodology: This review is based on an observation of Laparoscopic Cholecystectomy in a 3-star private hospital on a middle socioeconomic woman, followed by literature review and costs across India by the end of 2022.

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model.

The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. LC can be performed using different techniques, although the use of EBVS is highly recommended.

Integration of ICG-fluorescence cholangiography into the safety system of laparoscopic cholecystectomy

Is evaluating the possibility of integrating ICG-fluorescent cholangiography into the general safety system for laparoscopic cholecystectomy to prevent damage to the extrahepatic bile ducts by working out the methodological aspects of navigation technologies. The analysis of literature data on various approaches to improve the perioperative identification of anatomical structures during laparoscopic cholecystectomy, including the ICG-fluorescent cholangiography, was carried out. This program was implemented during the provision of elective surgical care to 24 patients with cholelithiasis who underwent laparoscopic cholecystectomy with ICG-fluorescent navigation. The developed program included: preoperative assessment of the anatomy of the biliary tree using MRCP; intraoperative technique of safe laparoscopic cholecystectomy with mandatory application of the concept of «critical view of safety» (CVS), which allows the most effective identification of the necessary anatomical structures; the use of ICG-fluorescent cholangiography, which allows to improve the control of anatomical structures at all stages of the operations. The first experience of using ICG-fluorescent cholangiography testifies to the high informative value of the method, the possibility and prospects of integrating the technology into a comprehensive safety system during laparoscopic cholecystectomy.

Minimally Invasive Approaches for Cholecystectomy

Abstract Surgical removal of the gallbladder is cholecystectomy. In Western countries, laparoscopic cholecystectomy (LC) is widely used procedure. Single-incision LC (SILC), mini LC (MLC) these surgeries developed by doctors, also natural orifice transluminal endoscopic surgery to lessen the invasiveness of the treatment. The goal of this study was to see how effective these novel less invasive techniques for LC are in treating gallstone disease. The current literature is inadequate for a proper management of new LC procedures. None of these methods have shown to be superior to traditional LC. SILC is now not recommended since it is linked to the predominance of bile duct damage also incisional hernia. Even though hybrid transvaginal cholecystectomy is becoming more popular in objective practice, cholecystectomies are still experimental. As a result of the fact that it is standardized, because MLC is standardized and nearly identical to traditional laparoscopic surgery, it may provide limited benefits without increasing postoperative problems, making it suitable for routine elective cholecystectomy. The technological issues could be addressed by modifying new surgical equipment that needs to grow with the nuances of SILC and cholecystectomy. Regardless of where these treatments may be used in the upcoming days, robotization may be required to make them the standard of care.

Laparoscopic fluorescence imaging technique for visualizing biliary structures using sodium fluorescein: the result of a preclinical study in a porcine model.

Near-infrared fluorescence imaging has been recently applied in the field of hepatobiliary surgery. Our objective was to apply blue-light fluorescence cholangiography during laparoscopic surgery. Therefore, we designed a preclinical study to evaluate the feasibility of using blue-light fluorescence for cholangiography in a porcine model. Five millimeters of sodium fluorescein (SF) solution was administered into the gallbladder of 20 male 3-way crossbred (Landrace × Yorkshire × Duroc) pigs in laparoscopic approach. The biliary tree was observed under blue light (a peak wavelength of 450 nm) emitted from a commercialized light-emitting diode (LED) light source (XLS1 extreme, Chammed). In 18 of 20 porcine models, immediately after SF solution was administered into the gallbladder, it was possible to visualize the biliary tree under blue light emitted from the LED light source. This study provided a preclinical basis for using blue-light fluorescence cholangiography using SF in laparoscopic surgery. The clinical feasibility of blue-light fluorescence imaging techniques for laparoscopic cholecystectomy remained to be demonstrated.

The Comparison of Two-port Laparoscopic Cholecystectomy Technique and Standard Four-port Technique

The Comparison of Two-port Laparoscopic Cholecystectomy Technique and Standard Four-port Technique

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