Authors: K T Buddingh A N Morks H O ten Cate Hoedemaker C B Blaauw G M van Dam R J Ploeg H S Hofker V B Nieuwenhuijs
Publish Date: 2011/07/27
Volume: 26, Issue: 1, Pages: 79-85
Abstract
The CVS photographs were judged to be “conclusive” in 27 “probable” in 35 and “inconclusive” in 38 of the cases The IOC images performed better and were judged to be “conclusive” in 57 “probable” in 25 and “inconclusive” in 18 of the cases P 0001 compared with the photographs The observers indicated that they would feel comfortable transecting the cystic duct based on the CVS photographs in 52 of the cases and based on the IOC images in 73 of the cases P = 0004 The interobserver agreement was moderate for both methods kappa values 04–05 For patients with a history of cholecystitis both the CVS photographs and the IOC images were less frequently judged to be sufficient for transection of the cystic duct P = 0006 and 0017 respectivelyIn this series IOC was superior to photographs of the CVS for documentation of the biliary anatomy during laparoscopic cholecystectomy However both methods were judged to be conclusive only for a limited proportion of patients especially in the case of cholecystitis This study highlights that documenting assessment of the biliary anatomy is not as straightforward as it seems and that protocols are necessary especially if the images may be used for medicolegal purposes Documentation of the biliary anatomy should be addressed during training courses for laparoscopic surgeryBile duct injury BDI is a dreaded complication during both laparoscopic and classic open cholecystectomy The most severe type of BDI is complete transection of the common bile duct CBD and it occurs when the CBD is mistaken for the cystic duct An important safety measure for identifying the cystic duct is to establish the socalled critical view of safety CVS 1 In addition intraoperative cholangiography IOC may be used to assess the biliary anatomy Although opinions vary on whether IOC should be performed routinely or selectively IOC is associated with a reduction in the incidence of major BDI 2 3 4 5Currently the guidelines of the Dutch Society of Surgery advise that the CVS is to be documented for educational and medicolegal purposes 6 It should be documented in the operation notes and preferably supported by intraoperative images Two Dutch studies that assessed whether photographs or video images performed better at documenting the CVS yielded contradictory results 7 8 In both studies the CVS and thus cystic duct identification could be registered conclusively for only 34–70 of the patients
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