Critical View of Safety: A Safe Method to Prevent Bile Duct Injury from Laparoscopic Cholecystectomy

Abstract

The incidence of bile duct injury after laparoscopic cholecystectomy is 0.20 - 3.24%. This may cause post-operative morbidity to the patients. Factors associated with bile duct injury included training experience, disease severity, anomalous anatomy and technical errors. The “Critical view of safety” is a technique for dissection of the Calot’s triangle by clearing fatty and fibrous tissue for identification of cystic duct and cystic artery, which were directed into the gall bladder. This is a very important step before clipping and ligation of cystic duct and cystic artery for preventing bile duct injury. However, in case of the cleared anatomy was not visualized, intra-operative cholangiography or conversion to open cholecystectomy should be considered for patient safety.