Critical View of Safety for Safe Laparoscopic Cholecystectomy

Background: Different anatomy in laparoscopic view of the area around the gallbladder, especially the Calot's triangle, leads to misidentification of structures. Extrahepatic biliary system injuries lead to considerable morbidity, occasional mortality and medico-legal issues. Aim and Objectives: To assess the utility of "Critical View of Safety" (CVS) for a safe laparoscopic cholecystectomy, in terms of: frequency of occurrence, anatomical description and relationship with level of difficulty in performing laparoscopic cholecystectomy. Material and Methods: This is a prospective study including 50 cases of symptomatic gall stone disease, managed with laparoscopic cholecystectomy. The cases were grouped into three categories (easy, difficult and very difficult) using a validated scoring system. The CVS was identified and evaluated. The relationship between occurrence of complications and level of difficulty in performing the procedure was also noted. The results were analyzed using the Chi-square test. Results: The study included 17 males and 33 females. Majority of patients (34%) were in the age group of 21-30 years. The CVS was demonstrated in 68% of patients. Out of the 34 patients in whom CVS was demonstrated, 28 cases (82.3%) belonged to the 'easy' group and the relationship was statistically significant. The relationship between operating time and level of difficulty in performing laparoscopic cholecystectomy was statistically significant. Out of three cases with complications (bleeding and bile spillage), two cases (66.6%) were in the 'difficult' group. Conclusions: Safe dissection of Calot's triangle is vital for a successful outcome following laparoscopic cholecystectomy. The demonstration of CVS is an effort to standardize the approach to the cystic artery and duct, effectively avoiding the area of aberrant ductal and arterial anatomy. It is essential to implement evidence-based protocols for safe laparoscopic cholecystectomy using validated anatomical landmarks.