Application of critical view of safety （CVS） concept in laparoscopic cholecystectomy in southern Xinjiang Region

doi:10.3969/j.issn.1009-976X.2024.04.002

Abstract

Abstract: Objective To investigate the impact of the critical view of safety （CVS） concept on the safety and prognosis of laparoscopic cholecystectomy （LC） in the southern Xinjiang region. Methods A retrospective analysis was conducted on the clinical data of 104 LC cases performed at the First People's Hospital of Kashgar from May 2023 to August 2023, designated as the control group. Starting in September 2023, the CVS concept was introduced to the clinical doctors performing LC, and 67 LC patients meeting the inclusion criteria from the same period and center were designated as the CVS group. Perioperative indicators of the CVS group were collected, and the safety and postoperative recovery between the control group and the CVS group were compared and analyzed. Results There was no statistically significant difference in the general preoperative conditions between the two groups （P>0.05）. The incidence of intraoperative bile duct injury and delayed postoperative bile duct injury was lower in the CVS group compared to the control group. Additionally, blood loss and postoperative AST and ALT levels were significantly lower in the CVS group, with the differences being statistically significant （P<0.05）. Conclusion The CVS concept can significantly enhance the safety of LC procedures in primary regions like southern Xinjiang and effectively improve prognosis and prevent bile duct injuries.

Key words: Southern Xinjiang region, CVS, laparoscopic cholecystectomy, BDI

摘要： 目的探究关键安全视野（CVS）理念对南疆地区腹腔镜胆囊切除术（LC）安全性及其预后的影响。方法回顾性分析喀什地区第一人民医院2023年5~8月完成的104例LC手术病例的临床资料,将其设置为对照组;同时对2023年9月之后的实施LC的临床医生传输CVS的理念,从同期同中心的病例中纳入符合入组标准的67例LC患者,将其设置为CVS组。收集CVS组患者围手术期各项指标,对比分析对照组和CVS组手术安全性差异及术后恢复情况。结果两组在术前一般情况差异无统计学意义（P>0.05）。CVS组的术中胆道损伤和术后迟发性胆道损伤低于对照组,出血量和术后AST、ALT显著低于对照组,差异有统计学意义（P<0.05）。结论 CVS理念能显著提高南疆等基层地区LC的手术安全性,并有效改善预后,预防胆管损伤。

关键词: 南疆地区, CVS, 腹腔镜胆囊切除术, 胆道损伤

CLC Number:

R657.4

ZHANG Ji-hao, SALAMU Mi-ji-ti, CAO Yan-long, TANG Hao-ze, KAHAER Tu-er-xun, LIAO Hao, CHEN Ya-jin, CHEN Jie. Application of critical view of safety （CVS） concept in laparoscopic cholecystectomy in southern Xinjiang Region[J]. Lingnan Modern Clinics In Surgery, 2024, 24(04): 215-219.

章纪豪, 萨拉木·米吉提, 曹彦龙, 汤浩泽, 卡哈尔·吐尔逊, 廖昊, 陈亚进, 陈捷. 关键安全视野理念在南疆地区腹腔镜胆囊切除术的应用研究[J]. 岭南现代临床外科, 2024, 24(04): 215-219.

References

[1] Brunt LM, Deziel DJ, Telem DA, et al.Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy[J]. Ann Surg, 2020, 272(1): 3-23.
[2] Barrett M, Asbun HJ, Chien HL, et al.Bile duct injury and morbidity following cholecystectomy: a need for improvement[J]. Surg Endosc, 2018, 32(4): 1683-1688.
[3] Van De Graaf FW, Zaïmi I, Stassen LPS, et al. Safe laparoscopic cholecystectomy: A systematic review of bile duct injury prevention[J]. Int J Surg, 2018, 60: 164-172.
[4] Mori Y, Itoi T, Baron T H, et al.Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1): 87-95.
[5] Okamoto K, Suzuki K, Takada T, et al.Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1): 55-72.
[6] Malvaux P, Gherardi D, Gryspeerdt F, et al.The utility of the CADISS^® system in laparoscopic cholecystectomy for acute cholecystitis[J]. Surg Endosc, 2022, 36(12): 9462-9468.
[7] Omar MA, Kamal A, Redwan AA, et al.Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results[J]. Int J Surg, 2023, 109(5): 1208-1221.
[8] Pesce A, Fabbri N, Feo CV.Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication[J]. World J Gastrointest Surg, 2023, 15(3): 338-345.
[9] Tsalis K, Antoniou N, Koukouritaki Z, et al.Open-access technique and “critical view of safety” as the safest way to perform laparoscopic cholecystectomy[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(2): 119-24.
[10] Zarin M, Khan MA, Khan MA, et al.Critical view of safety faster and safer technique during laparoscopic cholecystectomy?[J]. Pak J Med Sci, 2018, 34(3): 574-577.
[11] Gupta V, Jain G.Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy[J]. World J Gastrointest Surg, 2019, 11(2): 62-84.
[12] Mascagni P, Rodríguez-Luna MR, Urade T, et al.Promoting the Critical View of Safety for Safe Laparoscopic Cholecystectomy: Notes on Awareness and Correct Implementation[J]. J Am Coll Surg, 2022, 234(6): 1262-1263.
[13] Khalid H, Khan NA, Aziz MA.What is the critical view of safety in laparoscopic cholecystectomy? -Correspondence[J]. Int J Surg, 2022, 104: 106728.
[14] Manatakis DK, Antonopoulou MI, Tasis N, et al.Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives[J]. World J Surg, 2023, 47(3): 640-648.
[15] Gupta V.How to achieve the critical view of safety for safe laparoscopic cholecystectomy: Technical aspects[J]. Ann Hepatobiliary Pancreat Surg, 2023, 27(2): 201-210.
[16] Komatsu M, Yokoyama N, Katada T, et al.Learning curve for the surgical time of laparoscopic cholecystectomy performed by surgical trainees using the three-port method: how many cases are needed for stabilization?[J]. Surg Endosc, 2023, 37(2): 1252-1261.
[17] Sanford DE.An Update on Technical Aspects of Cholecystectomy[J]. Surg Clin North Am, 2019, 99(2): 245-258.
[18] Alanis-Rivera B, Rangel-Olvera G.Evaluation of the knowledge of the critical view of safety and recognition of the transoperative complexity during the laparoscopic cholecystectomy[J]. Surg Endosc, 2022, 36(11): 8408-8414.
[19] Alius C, Serban D, Bratu DG, et al.When Critical View of Safety Fails: A Practical Perspective on Difficult Laparoscopic Cholecystectomy[J]. Medicina (Kaunas), 2023, 59(8).
[20] Osailan S, Esailan M, Alraddadi AM, et al.The Use of Intraoperative Cholangiography During Cholecystectomy: A Systematic Review[J]. Cureus, 2023, 15(10): e47646.
[21] Ramírez-Giraldo C, Torres-Cuellar A, Van-Londono I.State of the art in subtotal cholecystectomy: An overview[J]. Front Surg, 2023, 10: 1142579.
[22] Nassar A, Elshahat I, Forsyth K, et al.Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis[J]. HPB (Oxford), 2022, 24(10): 1622-1633.
[23] Nakanuma H, Endo Y, Fujinaga A, et al.An intraoperative artificial intelligence system identifying anatomical landmarks for laparoscopic cholecystectomy: a prospective clinical feasibility trial (J-SUMMIT-C-01)[J]. Surg Endosc, 2023, 37(3): 1933-1942.
[24] Iacuzzo C, Bressan L, Troian M, et al.The Added Value of Intraoperative Near-Infrared Fluorescence Imaging in Elective Laparoscopic Cholecystectomy[J]. Surg Innov, 2022, 29(6): 716-722.
[25] Stolz MP, Foxhall EN, Gibson BH, et al.Improving the Safety of Laparoscopic Cholecystectomy with Indocyanine Green Dye Using Critical View of Safety Plus[J]. Am Surg, 2023, 89(7): 3136-3139.
[26] Kovács N, Németh D, Földi M, et al.Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis[J]. Surg Endosc, 2022, 36(10): 7126-7139.