The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Roberta Tutino, Luigi Monaco, Cosimo Feleppa, Salvatore Tolone, Davide Pertile, Fabio Medas, Gianfranco Muntoni, Francesco Guida, Angela Gurrado, Walter Bugiantella, Stefano Berti, Riccardo Memeo, Gianluca Piccirillo, Andrea Massobrio, Marco Milone, Gian Luca Baiocchi, Gianandrea Baldazzi, Marco Rigamonti, Claudio Gambardella, Tommaso FontanaFrancesco Vittore, Denise Palombo, Michele Crespi, Paolo Bianco, Michele Zuolo, Luca Fabris, Alessandro Pasculli, Giovanna Di Meo, Valentina Ferraro, Nicola De Angelis, Lucia Ilaria Sgaramella, Gennaro Perrone, Nicola De Angelis, Andrea Gennai, Mario Musella, Enrico Traverso, Francesco Paolo Prete, Francesco Paolo Prete, Luca Fabris, Roberta Tutino, Gennaro Perrone, Angela Pezzolla, Laura Invernizzi, Michele De Rosa, Laura Invernizzi, Carlo Valduga, Gianfranco Muntoni, Giovanni Ciaccio, Michele Zuolo, Francesco Guida, Luigi Monaco, Michele Zuolo, Gianfranco Muntoni, Laura Invernizzi, Laura Invernizzi, Gianluca Piccirillo, Giovanni Ciaccio, Carlo Somaglino, Roberto Perinotti, Mario Battocletti, Stefano Scabini, Carlo De Werra, Ludovico Docimo, Fausto Catena, Marco Scatizzi, Roberto Polastri, Giovanni Ciaccio, Giovanni Conzo, Sergio Bertoglio, Mario Testini, Ferdinando Cafiero, Roberto Ruggiero, Graziano Ceccarelli, Francesco Giuseppe Aldo Badessi, Nicola Solari, Lorenzo Cobianchi, Flavio Giuseppe Guida, Maria Rosaria De Rosa

Risultato della ricerca: Articlepeer review

15 Citazioni (Scopus)


Background: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods: Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results: Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions: The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.
Lingua originaleEnglish
Numero di pagine11
RivistaSurgical Endoscopy
Stato di pubblicazionePublished - 2020

All Science Journal Classification (ASJC) codes

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