Patient and Surgeon Predictors of Achieving the Critical View of Safety in Laparoscopic Cholecystectomy: A Prospective Cohort Study

Division

West Florida

Hospital

Citrus Memorial Hospital

Document Type

Manuscript

Publication Date

9-25-2025

Keywords

Calot's triangle, Nassar difficulty grading scale, Tokyo guidelines, acute cholecystitis, bile duct injury, critical view of safety, intraoperative cholangiography, laparoscopic cholecystectomy

Disciplines

Digestive System Diseases | Medicine and Health Sciences | Surgery | Surgical Procedures, Operative

Abstract

INTRODUCTION: The Critical View of Safety (CVS) is a cornerstone of safe laparoscopic cholecystectomy (LC), aimed at minimizing the risk of bile duct injury (BDI). However, consistent achievement of CVS remains a challenge in surgical practice. The primary outcome of this study was to assess the rate of CVS achievement and to identify patient, disease and surgeon related predictors.

METHODS: A prospective cohort of 150 patients undergoing LC was analyzed. Demographic data, preoperative risk factors, intraoperative variables, and surgeon characteristics were examined. CVS assessment was performed using Strasberg's criteria. Binary logistic regression and Chi-squared test were used to identify independent predictors of CVS achievement.

RESULTS: The rate of CVS achievement in this study was 69.6% among consultants and 60.0% among residents. Logistic regression identified ASA grade I (

CONCLUSION: Both preoperative and intraoperative factors can influence a surgeon's ability to achieve CVS. In our study, lower ASA grade, emergency cholecystectomies, acute cholecystitis and operations performed by non-HPB surgeons were associated with a higher likelihood of achieving CVS. Standardized protocols and structured training may help improve CVS documentation across practice settings.

Publisher or Conference

Frontiers in Surgery

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