Before clipping or dividing anything in laparoscopic cholecystectomy, confirm the critical view of safety: the hepatocystic triangle cleared of fat and fibrous tissue, the lower part of the gallbladder separated from the liver bed, and two structures only entering the gallbladder.
When inflammation makes that view impossible, a bailout such as subtotal cholecystectomy or fundus-first dissection is safer than pushing on.
- Confirm the critical view of safety before clipping any structure.
- Photograph or record the view for the operative note.
- If the view cannot be reached, stop and use a bailout approach.
- Ask for a second opinion early when anatomy is unclear.
Why it matters
Bile duct injury follows misidentification, and the check costs seconds.
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