Standardization of a safe surgical approach in laparoscopic cholecystectomy

a proposal based on 10 years of experience

Abstract

Introduction: laparoscopic cholecystectomy is the gold standard technique for treating cholelithiasis. To reduce the incidence of iatrogenic bile duct injuries during the procedure, the concept of the critical view of safety was developed. The main objective of this study is to present a proposal for surgical standardization to prevent iatrogenic complications. Methods: the approach described in this article was developed over 10 years of experience in the teaching service for the General Surgery Residency Program at the Dr. José Frota Institute Hospital. It is based on selected articles published between 2003 and 2024 from the following databases: Medical Literature Analysis and Retrieval System (MEDLINE/PubMed), Scientific Electronic Library Online (SciELO), Biblioteca Virtual em Saúde (BVS), and the Cochrane Library. The descriptors used were “laparoscopic cholecystectomy,” “critical view of safety,” and “surgical standardization.” Results: based on a literature review and 10 years of professional experience, a surgical standardization proposal was developed consisting of ten steps to be followed during laparoscopic cholecystectomy to achieve the critical view of safety more quickly and safely. It is important to note, however, that this method is intended for identifying anatomical structures (bile duct and adjacent structures) and not as a technique for the dissection of these structures. Final considerations: the ten steps represent a standardized approach that enables the procedure to be performed safely, regardless of the surgeon's experience, thereby contributing to the reduction of iatrogenic injuries.