The evaluation of B-SAFE and ultrasonographic landmarks in safe orientation during laparoscopic cholecystectomy.

Abstract

Introduction: Even though the prevalence of bile duct injury (BDI) is nowadays lower than before and close to the era of open cholecystectomy, there is a strong need to make it even lower. B-SAFE is a group of five visual landmarks that may be used before dissection in the hepatocystic triangle for better orientation around the gallbladder. Another method is laparoscopic ultrasound (LUS), which enables confirmation of structures in the hepatoduodenal ligament and delineation of the safe plane of dissection. Aim: To evaluate the use of B-SAFE and ultrasonographic landmarks during laparoscopic cholecystectomy in navigation around the gallbladder. Material and methods: The study group consisted of 158 patients with symptomatic cholecystolithiasis. The methods of intraoperative orientation around the gallbladder attempted in every patient during laparoscopic cholecystectomy included B-SAFE and ultrasonographic landmarks. Results: The identification rate of ultrasonographic landmarks-the upper border of "Mickey Mouse" sign (MMS) (the equivalent of the Rouviere's sulcus), the bile duct, and the hepatic artery-was significantly higher in patients with body mass index ≥ 30 kg/m 2 and fibrosis and chronic inflammation in the gallbladder neck than B-SAFE. LUS was also significantly more successful in the identification of the bile duct in the whole study group than B-SAFE. There were no significant differences according to the identification of the duodenum. The conversion rate was 2.6%, and we did not observe any BDI. Conclusions: Visual landmarks defined in B-SAFE are not as reliable as ultrasonographic landmarks; thus, LUS should be taken into consideration in the first place as a method of navigation around the gallbladder.

Effect of Microscope Combined with Wechat Smart Platform on Clinical Efficacy and Gastrointestinal Function of Patients with Cholecystolithiasis Combined with Common Bile Duct Stones

“…Sebastian, M. and others used laparoscopic cholecystectomy to treat common bile duct stones. It shows that laparoscopic cholecystectomy combined with choledochotomy and choledochofiberscope lithotomy T-tube drainage can reduce blood loss and shorten abdominal drainage time, intestinal function normalization time, and hospital stay [ 7 ]. Akool, M. A. and others studied that laparoscopic cholecystectomy was used to treat common bile duct stones, and the postoperative complications were only 6% [ 8 ].…”

Risk prediction models for difficult cholecystectomy.

“…LC, as a mature technology, has become the standard operation for cholecystectomy, but severe complications such as biliary tract injury [ 4 , 5 ], biliary fistula, and abdominal infection may still occur during and after operation, which may increase the pain and economic burden to patients [ 6 ]. Thus, how to effectively predict and evaluate the difficulty and risk before surgery are the focus of our study.…”

Staying safe with laparoscopic cholecystectomy: the use of landmarking and intraoperative time-outs

“…In our institution, these landmarks are the fundus of the gallbladder (which may be the only immediately identifiable structure), the porta hepatis, the duodenum, the sulcus of Rouviere, the cystic plate, the hilar plate, the umbilical fissure, and the inferior boundary of dissection, which we also refer to as the Line of Safety (6). Another widely used approach is the B-SAFE landmarks; the bile duct, the sulcus of Rouviere, the left hepatic artery pulsation, the umbilical fissure, and the duodenum (Enteric) (7). According to expert consensus, the most important landmark to identify prior to dissection is the sulcus of Rouviere (8).…”