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We evaluated the efficacy of combining cystic artery dissection with a dorsal infundibular approach in comparison to the critical view of safety. By analyzing these techniques, we aim to refine laparoscopic cholecystectomy protocols and enhance patient safety by minimizing bile duct complications
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| critical view of saftey | Active Comparator | dissection was conducted to provide the critical view of safety prior to the clipping and division of the cystic duct and artery |
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| cystic artery dissection with dorsal infundibular dissection (CADID) | Experimental | by identification and dissection of the cystic artery along with dorsal infundibular dissection with maintaining the integrity of the hepatocystic triangle |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| critical view of saftey | Procedure | Achievement of the Critical View of Safety (CVS) requires the completion of three mandatory criteria prior to the application of clips: first, the complete clearance of all fibro-fatty tissue from the hepatocystic triangle; second, the mobilization of the lower pole of the gallbladder from the liver bed to expose at least the inferior third of the cystic plate; and finally, the clear demonstration of exactly two structures-the cystic duct and cystic artery-entering the gallbladder. Only upon definitive visualization of these components is the CVS considered achieved |
| Measure | Description | Time Frame |
|---|---|---|
| rate of iatrogenic bike duct unjury | Biliary Tract Injury will be monitored from the start of the surgical procedure through the 30-day postoperative follow-up period. This includes all intraoperative detections and any delayed presentations (leaks or strictures) confirmed via biochemical |
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Inclusion Criteria:
the study included adult patients who were candidates for laparoscopic cholecystectomy.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zagazig Univeesity Hospitals | Zagazig | Sharqia Province | Egypt |
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| cystic artery dissection with dorsal infundibular dissection | Procedure | Following optimized gallbladder retraction and identification of the Rouviere's sulcus, any existing adhesions were cleared via a combination of blunt and sharp dissection. The procedure commenced with a peritoneal incision on the right lateral aspect at the cysto-infundibular junction, facilitating lateral retraction of the infundibulum and opening of the hepatocystic (Calot's) triangle. Subsequently, the left-sided peritoneum was incised along the anterior border of the cystic artery, extending over the inferior fourth of the gallbladder. Precise hemostasis was maintained, particularly at the ductal branches, to ensure a clear operative field. Connecting the bilateral peritoneal incisions ventrally facilitated the creation of a retro-ductal window. This maneuver allowed for superior retraction of the infundibulum away from the common bile duct, effectively straightening the cystic duct for safer identification |
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