Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy

Abstract

The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: (1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; (2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; (3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; (4) proper gallbladder retraction; (5) safe use of various energy devices; (6) understanding the critical view of safety, including its doublet view and documentation; (7) awareness of various error traps ( e.g ., fundus first technique); (8) use of various bailout strategies ( e.g ., subtotal cholecystectomy) in difficult gallbladder cases; (9) use of intraoperative imaging techniques ( e.g ., intraoperative cholangiogram) to ascertain correct anatomy; and (10) understanding the concept of time-out. Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.

A prospective observational study: combined irrigation of bupivacaine at the gallbladder fossa with infiltration at port site for postoperative pain relief after laparoscopic cholecystectomy

“…This was comparable with previous studies. 1,2 thus, a decreased total analgesic requirement in comparison to the control faction as seen with previous studies. 1,2 with our findings, early post-surgical pain is believed to have been caused by peritoneum and diaphragm irritation, and bupivacaine application would reduce post-operative pain.…”

“…No significant statistical difference was observed as compared with the previous studies. 1,2 the timing of oral intake and ambulation were comparable in both groups in relation to previous studies. 1,2 Of the 160 patients recruited in the study, 124 required intravenous postoperative analgesics; 48 patients were in the bupivacaine community and 76 from the control faction.…”

“…In the era of laparoscopic cholecystectomy, early discharge and return to routine activity have become feasible owing to minimal invasion. 1 The post-operative compliance from the patient and the satisfaction level has significantly improved with this technique. The management of pain in the postoperative period is crucial in aiding the recovery of the patient.…”

The segment IV approach: a useful method for achieving the critical view of safety during laparoscopic cholecystectomy in patients with anomalous bile duct

“…Recently, Tokyo Guidelines 2018 described that LC should be performed above the imaged line between the base of segment IV of the liver and the roof of the Rouviére's sulcus for safe LC [9]. Similar referenced line proposed by Gupta et al in 2019 , in which LC must be done ventral and cephalad to the line joining the roof of the Rouviére's sulcus and base of segment 4 [11]. We proposed the segment IV approach in 2019, which is based on the operative management for safe LC by dissecting the gallbladder rst along the D-line, the right edge of the hilar plate system.…”

The segment IV approach: a useful method for achieving the critical view of safety during laparoscopic cholecystectomy in patients with anomalous bile duct

“…Recently, Tokyo Guidelines 2018 described that LC should be performed above the imaged line between the base of segment IV of the liver and the roof of the Rouviére’s sulcus for safe LC [ 4 ]. Similar referenced line proposed by Gupta et al in 2019, in which LC must be done ventral and cephalad to the line joining the roof of the Rouviére’s sulcus and base of segment 4 [ 11 ]. We proposed the segment IV approach in 2019, which is based on the operative management for safe LC by dissecting the gallbladder first along the D-line, the right edge of the hilar plate system.…”