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Laparoscopic cholecystectomy (LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety (CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon's assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations. Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC: (1) consideration that a high level of experience alone is not enough; (2) recognition of the plateau involving the common hepatic duct and hepatic hilum; (3) blunt dissection until CVS exposure; (4) Calot's triangle clearance in the overhead view; (5) Calot's triangle clearance in the view from underneath; (6) dissection of the posterior right side of Calot's triangle; (7) removal of the gallbladder body; and (8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.
Critical view of safety, Biliary Tract Diseases, Gallbladder, Review, Biliary injury, Laparoscopic cholecystectomy, Treatment Outcome, Cholecystectomy, Laparoscopic, Clinical Protocols, Elective Surgical Procedures, Risk Factors, Protocol, Humans, Clinical Competence, Patient Safety, Learning Curve
Critical view of safety, Biliary Tract Diseases, Gallbladder, Review, Biliary injury, Laparoscopic cholecystectomy, Treatment Outcome, Cholecystectomy, Laparoscopic, Clinical Protocols, Elective Surgical Procedures, Risk Factors, Protocol, Humans, Clinical Competence, Patient Safety, Learning Curve
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | 29 | |
popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network. | Top 10% | |
influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | Top 10% | |
impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network. | Top 10% |