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Multicenter Study
. 2021 Jul;35(7):3698-3708.
doi: 10.1007/s00464-020-07852-6. Epub 2020 Aug 11.

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Lucia Ilaria Sgaramella  1 , Angela Gurrado  2 , Alessandro Pasculli  2 , Nicola de Angelis  3 , Riccardo Memeo  4 , Francesco Paolo Prete  2 , Stefano Berti  5 , Graziano Ceccarelli  6 , Marco Rigamonti  7 , Francesco Giuseppe Aldo Badessi  8 , Nicola Solari  9 , Marco Milone  10 , Fausto Catena  11 , Stefano Scabini  9 , Francesco Vittore  2 , Gennaro Perrone  11 , Carlo de Werra  10 , Ferdinando Cafiero  9 , Mario Testini  2 ; SYoN Italian Collaborative Group
Collaborators, Affiliations
Multicenter Study

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Lucia Ilaria Sgaramella et al. Surg Endosc. 2021 Jul.

Abstract

Background: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3-0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial.

Methods: Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor.

Results: Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding.

Conclusions: The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.

Keywords: Bile duct injuries; Cholecystectomy; Critical view of safety; Intraoperative bleeding; Laparoscopic training; Laparoscopy.

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Conflict of interest statement

Sgaramella Lucia Ilaria, Gurrado Angela, Pasculli Alessandro, de Angelis Nicola, Memeo Riccardo, Prete Francesco Paolo, Berti Stefano, Ceccarelli Graziano, Rigamonti Marco, Badessi Francesco, Solari Nicola, Milone Marco, Catena Fausto, Scabini Stefano, Vittore Francesco, Gennaro Perrone, de Werra Carlo, Cafiero Fernando, Testini Mario and all authors of SYoN collaborative group have no conflicts of interest nor financial ties to disclose.

Figures

Fig. 1
Fig. 1
A–D Intraoperative photo of the Calot’s triangle dissection according to CVS principles and reviewed by the external auditor
See this image and copyright information in PMC

References

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