Abstract
Bile duct injuries are the most common serious complication of cholecystectomy. Avoidance of bile duct injury is a key aim of biliary surgery. The purpose of this paper is to describe laparoscopic cholecystectomy from the viewpoint of three conceptual goals. Three conceptual goals of cholecystectomy are: (1) getting secure anatomical identification of key structures; (2) making the right decision not to perform a total cholecystectomy when conditions are too dangerous to get secure identification – the “inflection point”; and (3) finishing the operation safely when secure anatomical identification of cystic structures is not possible. The Critical View of Safety (CVS) has been shown to be a good way of getting secure anatomical identification. Conceptually, CVS is a method of target identification, the targets being the two cystic structures. Sometimes, anatomic identification is not possible because the risk of biliary injury is judged to be too great. Then a decision is made to abandon the attempt to do a complete cholecystectomy – and instead to “bail-out”. This “inflection point” is defined as the moment at which the decision is made to halt the attempt to perform a total cholecystectomy laparoscopically and to finish the operation by a different method. Currently the best bail-out procedure seems to be subtotal fenestrating cholecystectomy. Application of conceptual goals of cholecystectomy can help the surgeon to avoid biliary injury.
Original language | English |
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Pages (from-to) | 123-127 |
Number of pages | 5 |
Journal | Journal of Hepato-Biliary-Pancreatic Sciences |
Volume | 26 |
Issue number | 4 |
DOIs | |
State | Published - Apr 2019 |
Keywords
- Acute cholecystitis
- Bile duct injury
- Biliary colic
- Biliary injury
- Cholecystectomy
- Critical view of safety
- Inflection point
- Laparoscopic cholecystectomy
- Subtotal cholecystectomy
- Subtotal fenestrating cholecystectomy
- Subtotal reconstituting cholecystectomy