Before clipping or dividing any structure in laparoscopic cholecystectomy, establish the critical view of safety: the hepatocystic triangle cleared, the lower third of the gallbladder separated from the liver bed, and only two structures entering the gallbladder. If inflammation prevents this, stop and change plan rather than pressing on. Subtotal cholecystectomy, cholangiography, conversion or calling a colleague are all accepted bailouts.
- Confirm all three elements of the critical view before clipping anything.
- Take a photograph or record the view in the operation note.
- If the view cannot be achieved, choose a bailout rather than continuing dissection.
- Subtotal cholecystectomy is a legitimate safe outcome, not a failure.
Why it matters
Most bile duct injuries follow misidentification, which the critical view exists to prevent.
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