Injury to the hepatocholedochal duct during laparoscopic cholecystectomy is a serious complication. Critical view of safety, or CVS for short, is a concept that was developed to reduce the frequency of such injuries. It involves the identification of the hepatocholedochal duct, the cystic duct and the cystic artery with separation of the structures from each other and from the gallbladder, including photographic documentation. To date, there is no grading of the images according to a grading system.
A retrospective study analysed patients with laparoscopic cholecystectomy for a period from July 2018 to December 2021. Various parameters such as age, gender, surgical procedure, perioperative and postoperative complications were examined. Of the 735 patients included, 534 had laparoscopic surgery, for which the CVS images were analysed in a structured manner. The quality of the CVS images was evaluated using a grading system from 1 for very good to 5 for poor to analyse the influence of the grades on the perioperative outcome. The average CVS grade was 1.9.
The CVS quality influences the perioperative outcome, as shown by the results of the retrospective study. It was found that patients with a better CVS score had significantly shorter procedure times and hospital stays and fewer postoperative complications. In particular, patients with a CVS score of 1 had a lower complication rate and shorter hospital stay compared to patients with a score of 4 or 5. The CVS score may therefore help to prevent injuries to the biliary system during laparoscopic cholecystectomy and improve the perioperative course.
source: Fischer, L. et al. Die klinische Bedeutung des „critical view of safety“ in der laparoskopischen Gallenblasenchirurgie. Chirurgie 94, 544–549 (2023).