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06-12-2022 | Cholecystectomy | Scientific Review

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

Authors: Dimitrios K. Manatakis, Maria-Ioanna Antonopoulou, Nikolaos Tasis, Christos Agalianos, Ioannis Tsouknidas, Dimitrios P. Korkolis, Christos Dervenis

Published in: World Journal of Surgery | Issue 3/2023

Abstract

Background

The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives.

Method

We systematically reviewed the literature (1995–2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI).

Results

150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail-out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS-related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors).

Conclusion

Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail-out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.

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Title: Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives
Authors: Dimitrios K. Manatakis
Maria-Ioanna Antonopoulou
Nikolaos Tasis
Christos Agalianos
Ioannis Tsouknidas
Dimitrios P. Korkolis
Christos Dervenis
Publication date: 06-12-2022
Publisher: Springer International Publishing
Keyword: Cholecystectomy
Published in: World Journal of Surgery / Issue 3/2023
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-022-06842-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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