The critical view of safety in laparoscopic cholecystectomy is optimized by exposing the inner layer of the subserosal layer

被引:40
作者
Honda, Goro [1 ]
Iwanaga, Tomohiro [1 ]
Kurata, Masanao [1 ]
Watanabe, Fumiaki [1 ]
Satoh, Hiroki [1 ]
Iwasaki, Ken-ichi [1 ]
机构
[1] Tokyo Metropolitan Komagome Hosp, Tokyo Metropolitan Canc & Infect Dis Ctr, Dept Surg, Bunkyo Ku, Tokyo 1138677, Japan
来源
JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY | 2009年 / 16卷 / 04期
关键词
Critical view of safety; Laparoscopic cholecystectomy; Subserosal layer; Rouviere's sulcus; BILIARY INJURY; CYSTIC ARTERY;
D O I
10.1007/s00534-009-0060-3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
During laparoscopic cholecystectomy (LC), misidentification of the cystic duct, which causes major bile duct injuries, can result from wrong or incomplete dissection of Calot's triangle. Therefore, the critical view of safety has been accepted as a safe method for gaining a sufficient view of Calot's triangle before transecting the cystic duct. However, even in cases without aberrant anatomy of the bile duct, bile duct injury can occur by a wrong approach to a critical view of safety. Additionally, in cases of badly inflamed gallbladders, it is often hard to achieve a critical view of safety, because Calot's triangle is often solid and cannot be expanded. In our standardized procedure, which is based on exposing the inner layer of the subserosal layer (the ss-i layer), the critical view of safety can be safely achieved. We have safely performed LC, using our standardized procedure, for many cases with cholecystitis with highly inflamed gallbladders. In this article, focusing especially on prevention of bile duct injuries, we present our standardized procedure to achieve the critical view of safety along with histological findings.
引用
收藏
页码:445 / 449
页数:5
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