Cystic Lymph Node Identification Is More Reliable Than Critical View of Safety in Difficult Cholecystectomies.
| Autor: | Ng HJ; NHS Greater Glasgow and Clyde, Glasgow., Nassar AHM; University Hospital Monklands, Scotland, UK., Wysocki AP; Logan Hospital, Meadowbrook, Queensland, Australia., Ahmed Z; NHS Greater Glasgow and Clyde, Glasgow., Gil IC; Central Hospital of Leiria, Leiria, Portugal. |
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| Jazyk: | angličtina |
| Zdroj: | Surgical laparoscopy, endoscopy & percutaneous techniques [Surg Laparosc Endosc Percutan Tech] 2021 Jan 20; Vol. 31 (2), pp. 155-159. Date of Electronic Publication: 2021 Jan 20. |
| DOI: | 10.1097/SLE.0000000000000900 |
| Abstrakt: | Background: The cystic lymph node (CLN) represents an anatomic safety marker and a surrogate marker of technique during laparoscopic cholecystectomy (LC). We aim to demonstrate the value of CLN in comparison to the critical view of safety (CVS) and study the effects of increasing difficulty on the 2 approaches. Methods: A prospective study of consecutive LC was conducted. Patient demographics, type of admission, clinical presentation, operative difficulty grade, visualization of CLN, identification of CVS, operative time, and complications were recorded and analyzed. Results: Of 393 LCs, half of the admissions were emergencies. Thirty-four percent had obstructive jaundice or acute cholecystitis. The CLN was visually identified in 81.7% with a small difference between operative difficulty grades 1 to 3 versus 4 to 5. Although CVS was unachievable in 62 patients, 43 (69.4%) still had an identifiable CLN. The median operating time was 68 minutes with 1 mortality but no conversions or intraoperative complications. Conclusions: Identifying the CLN during LC could compliment the CVS in avoiding major ductal injury. Dissecting lateral to the CLN to commence the process of displaying the cystic pedicle structures may be a strategy in safely achieving the CVS. During the more difficult LC where displaying the CVS is impossible, the CLN may be the key anatomic landmark. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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