When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy

Autor: Catalin Alius, Dragos Serban, Dan Georgian Bratu, Laura Carina Tribus, Geta Vancea, Paul Lorin Stoica, Ion Motofei, Corneliu Tudor, Crenguta Serboiu, Daniel Ovidiu Costea, Bogdan Serban, Ana Maria Dascalu, Ciprian Tanasescu, Bogdan Geavlete, Bogdan Mihai Cristea
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Medicina, Vol 59, Iss 8, p 1491 (2023)
Druh dokumentu: article
ISSN: 1648-9144
1010-660X
DOI: 10.3390/medicina59081491
Popis: The incidence of common bile duct injuries following laparoscopic cholecystectomy (LC) remains three times higher than that following open surgery despite numerous attempts to decrease intraoperative incidents by employing better training, superior surgical instruments, imaging techniques, or strategic concepts. This paper is a narrative review which discusses from a contextual point of view the need to standardise the surgical approach in difficult laparoscopic cholecystectomies, the main strategic operative concepts and techniques, complementary visualisation aids for the delineation of anatomical landmarks, and the importance of cognitive maps and algorithms in performing safer LC. Extensive research was carried out in the PubMed, Web of Science, and Elsevier databases using the terms ”difficult cholecystectomy”, ”bile duct injuries”, ”safe cholecystectomy”, and ”laparoscopy in acute cholecystitis”. The key content and findings of this research suggest there is high intersocietal variation in approaching and performing LC, in the use of visualisation aids, and in the application of safety concepts. Limited papers offer guidelines based on robust data and a timid recognition of the human factors and ergonomic concepts in improving the outcomes associated with difficult cholecystectomies. This paper highlights the most relevant recommendations for dealing with difficult laparoscopic cholecystectomies.
Databáze: Directory of Open Access Journals
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