The Critical View of Safety: Creating Procedural Safety Benchmarks

Laparoscopic cholecystectomy is one of the most common procedures performed by general surgeons worldwide. Although complications occur infrequently, serious adverse events such as bile duct injury still occur at a frequency somewhat higher than reported prior to the development of laparoscopic cholecystectomy. Optimization of safe performance of this procedure can be enhanced by a number of principles as espoused in the SAGES safe cholecystectomy program. These initiatives include the SAGES six-step program, the SAGES safe cholecystectomy didactic modules, and the recently published multi-society consensus conference clinical practice guideline on prevention of bile duct injury during cholecystectomy. Foremost among these is understanding and applying the critical view of safety (CVS) as well as knowing when to alter the approach when the CVS cannot be achieved. In this chapter, these principles along with the rationale behind them are reviewed in detail.