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

Fujioka, Shozo; Nakashima, Kenji; Kitamura, Hiroaki; Takano, Yuki; Misawa, Takeyuki; Kumagai, Yoshito; Hata, Toshiaki; Akiba, Tadashi; Ikegami, Toru; Yanaga, Katsuhiko

doi:10.1186/s12893-020-00873-x

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…[15,36,37,43] Although there are models predicting difficulty, they are complex and not practical. [7][8][9][10]24,25,34,44,[44][45][46][47][48] . To predict the use of a bailout procedure in a more practical way, we estimated the area under the ROC curve of the time (minutes) spent trying to dissect the CD and found that it predicts the use of bailout techniques, as well as being a good predictor of conversion (see Graphs 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

2023

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Background: The Tokyo 2018 guidelines call for the study of quantitative predictors of surgical difficulty in laparoscopic cholecystectomy for complete cholecystectomy in a safe context. Objective: To evaluate the cystic duct (CD) dissection time as a predictor of surgical difficulty. Materials and methods: This prospective study included 193 patients who underwent laparoscopic cholecystectomy in 2022 and were grouped according to the indication for cholecystectomy: Urgent, Delayed, and Elective. Multiple linear regression and multinomial logistic regression analyses were used to identify the preoperative and operative predictive variables of surgical difficulty. The predictive value of the time spent dissecting the CD was estimated using a ROC curve. Results: The CD dissection time of 13 min had 100% sensitivity and 99% specificity, PPV 100%, NPV 1%, OR 3.3 to predict the use of bailout techniques. Conclusions: The time required to dissect the cystic duct, with or without success, is a practical predictor of the subsequent use of bailout procedures and, consequently, predicts the "Risk/Difficult Cholecystectomy". Keywords: Difficult laparoscopic cholecystectomy, predictors of difficult cholecystectomy, bailout procedures, cystic dissection time, risk of cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

2023

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“…So, it is absolutely safe to dissect in this area regardless of the presence of any vascular or biliary anomalies, or severe inflammation in the Calot's triangle [ 1 ]. Fujioka et al [ 7 ] used the D-line approach for LC in patients with bile duct anomalies and found that it was safe and very effective in avoiding BDIs. The D-line served as a landmark to help surgeons dissect Calot's triangle to the right side and away from the hilar plate, which is known to be the convergence point for all biliary ducts, including the anomalous bile duct [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the D-line approach has been used but with some modifications to the previously described technique [ 1 , 7 ]. The falciform ligament was not tied or retracted extracorporeally because the cephalad retraction of the GB was enough to expose the inferior surface of segment IV.…”

Section: Methodsmentioning

confidence: 99%

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience

Badawy,

Fathi,

Sabra

2023

Cureus

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Introduction The critical view of safety is an important concept for safe laparoscopic cholecystectomy. However, no standard step-by-step approach for achieving the critical view of safety has been established until now. Therefore, this study aims to evaluate a new approach for achieving the critical view of safety using the diagonal line of liver segment IV as an anatomical landmark. Patients and methods In this prospective non-randomized study, patients (n= 112) who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis were included. The first 47 patients underwent laparoscopic cholecystectomy using the diagonal line approach (DLC group) whereas, the next 65 patients underwent laparoscopic cholecystectomy using the conventional method (CLC group). Results No significant difference between both groups regarding the preoperative characteristics, operative time, and intraoperative blood loss. Laparoscopic subtotal cholecystectomy was performed more in the DLC group (6% vs 0%, p= 0.07). Whereas, in the CLC group, there was a tendency towards conversion to open cholecystectomy in difficult cases (6% vs 2%, p= 0.40). No intra- or postoperative complications occurred in either group. Conclusion The diagonal line approach is a feasible and useful step-by-step technique to achieve the critical view of safety in laparoscopic cholecystectomy and enables surgeons to perform safe laparoscopic subtotal cholecystectomy in difficult cases.

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“…Fujioka et al . [ 29 ] used the “segment 4” approach for difficult laparoscopic cholecystectomy, which was a line connecting the right dorsal and left ventral corners of segment 4. However, the line of “segment 4” may be variable due to the different shapes of the quadrate lobe [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The hilar plane compared with the Rouviere's sulcus plane during laparoscopic cholecystectomy.

Wang¹,

Hou²,

Zhou³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Rouviere's sulcus (RS) has been widely used as an important landmark during laparoscopic cholecystectomy; however, some shortcomings remain unaddressed. Aim: To evaluate the safety and application values of the hilar plane in laparoscopic cholecystectomy (LC) by comparing it with the plane of Rouviere's sulcus (RS plane). Material and methods: A retrospective study of 155 consecutive patients undergoing LC used the hilar plane as a guide for surgical procedures was performed. Intraoperative images were used to evaluate and analyze the value of using the hilar plane vs. the RS plane in preventing bile duct and vascular injuries. Meanwhile, anatomical data, including the types and orientations of Rouviere's sulci, were also recorded for further analysis. Results: Rouviere's sulci failed to be identified clearly in nine cases due to severe adhesions. The prevalence of RS was 83.6% (122/146). The hilar plane was a constant landmark. The hilar plane can also form a "security dissection triangle" in the posterior triangle of the gallbladder. The hilar plane and the RS plane formed a similar triangle in 59.8% (73/122) of cases, while in other cases, the hilar plane formed a smaller dissection triangle than the RS plane due to a higher spatial position. The hilar plane had a better protective effect for avoiding ectopic hepatic ducts or ectopic right hepatic arteries injury. Conclusions: The hilar plane has the features of constant location, large coverage area, and higher location, hence being further away from the critical structures. The hilar plane on its own can provide a safe anatomic plane in some case when RS was difficult to observe or identify.

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

Cited by 10 publications

References 12 publications

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

Cystic Duct Dissection Time as a Predictor of Difficult Laparoscopic Cholecystectomy

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience

The hilar plane compared with the Rouviere's sulcus plane during laparoscopic cholecystectomy.

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