Conclusive Identification and Division of the Cystic Artery: A Forgotten Trick to Optimize Exposure of the Critical View of Safety in Laparoscopic Cholecystectomy.

Abstract

SHORT SUMMARY\nThe value of the critical view of safety (CVS) in preventing bile duct injuries during laparoscopic cholecystectomies partially resides in its extensive dissection requirements. Despite careful dissection, short cystic structures and high entering cystic arteries can at times impede to fully appreciate CVS. In such situations, the operator conclusively identifies the cystic artery by following it from its origin up into the gallbladder and by pulsation and then divides it to better expose the hepatocystic triangle. Strasberg and colleagues described this event in their first paper on the critical view, however subsequent publication overlooked this technical trick. We hereby generate the hypothesis that taking in consideration this often performed but under-described technical trick could increase CVS achievement rate and consequently help preventing BDI.