Safe Laparoscopic Cholecystectomy

Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include: 

(1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations; 

(2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury; 

(3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy; 

(4) proper gallbladder retraction; 

(5) safe use of various energy devices; 

(6) understanding the critical view of safety, including its doublet view and documentation; 

(7) awareness of various error traps (e.g., fundus first technique); 

(8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases; 

(9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy; and 

(10) understanding the concept of time-out. Meticulous dissection of the gallbladder border is necessary to avoid injury to biliary or vasculobiliary injury.