A gallbladder with the “hidden cystic duct”: A brief overview of various surgical techniques of the Calot’s triangle dissection

Kaczynski, Jakub; Hilton, Joanna

doi:10.1556/imas.7.2015.1.4

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…However, it seems that the CVS is an ideal destination for target identification but how to get there is not yet described in detail, and biliary injury may occur on the way to get there 12 , 17 . The infundibular method, which necessitates a view of a funnel-shaped structure resembling the junction of gallbladder and cystic duct, despite taking less dissection and easier than CVS, has been proved unreliable in the presence of sever inflammation 13 , 18 . The fundus-down cholecystectomy is an alternative in difficult circumstance; however, extreme vasculobiliary injuries tend to occur when this method is performed 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Although our method for target identification is based on the gallbladder infundibulum, it is worth pointing out that there is an essential difference between our method and the infundibulum technique. The anatomic rationale for cystic identification of infundibulum technique is based on three-dimensional demonstration of a flaring tunnel shape as the cystic duct-gallbladder junction 13 , 18 , which might be deceptive when the cystic duct was hidden. In our method, the first and the key step is to identify the position of infundibulum, especially the 3-o’clock and the 12-o’clock, rather than the structure appearing to flare.…”

Section: Discussionmentioning

confidence: 99%

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A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

Shang¹,

Liu²,

Li³

et al. 2020

Acta Cir. Bras.

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Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury. Methods A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-o’clock position as cranial, 6-o’clock as dorsal, 9-o’clock as caudal, and 12-o’clock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images. Results All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-o’clock position, 6-o’clock position, 9-o’clock position, 12-o’clock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-o’clock and 12-o’clock position were pitfalls that might cause biliary injury. Conclusion The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

Shang¹,

Liu²,

Li³

et al. 2020

Acta Cir. Bras.

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“…Nowadays, the CVS technique is the gold standard to perform a safe cholecystectomy with identification of the vital structures such as the CD. [16][17][18][19][20] According to a Dutch nationwide survey in 2011, 97.6% of the Dutch surgeons use the CVS technique. 21 However, according to a recent study by Nijssen et al, 22 only in 10% of the laparoscopic cholecystectomies CVS is actually established.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy (FALCON trial): study protocol for a multicentre randomised controlled trial

et al. 2016

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“…Advancements and research have failed to eliminate the disastrous event of a biliovascular injury. Be it the various described approaches[ 1 ] or the refinement of endoscopic vision and the recently introduced indocyanine green imaging; rates of biliovascular injuries are same.…”

Section: Introductionmentioning

confidence: 99%

Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy

et al. 2020

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Background: Laparoscopic Cholecystectomy one of the commonest procedures performed worldwide isn't spared from the risks of disastrous iatrogenic complications. In patients with obscured anatomy, the idea of performing a safe total cholecystectomy can be hindered with a high risk of biliovascular injuries. In such a situation STC (subtotal cholecystectomy) comes to the rescue, where the diseased organ can be tackled fairly, without any further damage. Aims and Objectives: The primary aim was to look at the immediate and long-term outcomes of subtotal cholecystectomy. Subgroup analysis was done based on demographics, indications and surgical approach. Materials and Methods: We reviewed our prospectively maintained computerized operation database over nine years. STC was defined as leaving behind any portion of gallbladder other than the cystic duct. They were subclassified as per the description given by Palanivelu. Patients were evaluated with laboratory and radiological assessment. Results: A total of 70 out of 602 patients (11.6%) underwent STC. Dense adhesion at the calot's was the most important reason for STC. Subtype B was the most common. Nine patients (12.85%) had a bile leak in the postoperative period. There were no biliary/vascular injuries and 30-day mortality was zero. 22.8% developed SSI (surgical site infection). Over a median follow up of 38 months (range 5-98), clinical examination, LFT and USG revealed no abnormality in any of the patients. Conclusion: Subtotal cholecystectomy is a useful alternative during difficult gallbladder surgery. It should be considered early into the procedure preferably prior to conversion to an open procedure. Biliovascular injuries can be avoided and the Immediate and long-term outcomes are acceptable.

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A gallbladder with the “hidden cystic duct”: A brief overview of various surgical techniques of the Calot’s triangle dissection

Cited by 9 publications

References 14 publications

A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy (FALCON trial): study protocol for a multicentre randomised controlled trial

Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy

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