The critical view of safety has three parts: the hepatocystic triangle cleared of fat and fibrous tissue, the lower third of the gallbladder separated from the liver bed, and only two structures seen entering the gallbladder. When inflammation prevents it, persisting is how bile duct injuries happen. Established bailout options are subtotal cholecystectomy, fundus-first dissection, cholecystostomy, or stopping and getting a second surgeon. Deciding the bailout before the operation becomes dangerous is the safer habit.
- Confirm all three components of the critical view of safety before clipping or dividing anything.
- Take a photograph or video of the critical view and record it in the operation note.
- If the critical view cannot be achieved, consider subtotal cholecystectomy, fundus-first dissection or cholecystostomy.
- Call a second experienced surgeon early in a difficult gallbladder.
Why it matters
Bile duct injury is mostly a judgement failure in a hard case, and a pre-agreed bailout removes the pressure to persist.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free