Protocol for laparoscopic cholecystectomy: Is it rocket science?

Abstract:

: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.

journal_name

World J Gastroenterol

authors

Hori T,Oike F,Furuyama H,Machimoto T,Kadokawa Y,Hata T,Kato S,Yasukawa D,Aisu Y,Sasaki M,Kimura Y,Takamatsu Y,Naito M,Nakauchi M,Tanaka T,Gunji D,Nakamura K,Sato K,Mizuno M,Iida T,Yagi S,Uemoto S,Yoshimura T

doi

10.3748/wjg.v22.i47.10287

subject

Has Abstract

pub_date

2016-12-21 00:00:00

pages

10287-10303

issue

47

eissn

1007-9327

issn

2219-2840

journal_volume

22

pub_type

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