Retrospective evaluation of “critical view of safety” in laparoscopic cholecystectomy

Abstract Objective The value of critical view of safety (CVS) for laparoscopic cholecystectomy (LC) was evaluated using retroactive surgical video recording and clinical data. Methods 172 patients who underwent LC in our center from January 2022 to December 2022 were selected and the complete operation video was retained. By reviewing the surgical video and clinical data, patients were divided into CVS group and unfinished CVS (U-CVS) group, comparing patients with different cholecystitis severity, gallbladder mesangial anatomy, bile duct injury(BDI), operation time, postoperative bile leakage and hospital length between the two groups. Performed logistic regression analysis on the risk factors of U-CVS in GRADE II/III (moderate/severe)cholecystitis, ROC curve was drawn to determine its predictive value. Results The proportion of LC achieving CVS in the center was 70.93% (122 /172), and the proportion of GRADE I, II and III cholecystitis patients was 85.98%, 49.12% and 25.00%, respectively. Compared with GRADE I group, the exposure rates of gallbladder mesangium (48.57% vs 80%), gallbladder neck / blood vessel (42.86% vs73.33%) in GRADE II / III group were lower, and the intraoperative bile duct injury (2.85%vs0%) was higher. The preoperative WBC > 18×109/L, BMI > 24kg/m2, previous gallbladder puncture, bile duct variation and incarceration of gall bladder neck stones were independent risk factors of U-CVS. ROC analysis showed that the above risk factors had good predictive performance(0.851). Conclusion CVS can reduce the incidence of IBD. Mild cholecystitis is prone to operate, while operation for moderate and severe cholecystitis is difficult, which is affected by preoperative WBC > 18×109/L, BMI > 24kg/m2, past history of gallbladder puncture, variation of bile duct and stones incarceration of gall bladder neck and other factors.