Cystic lymph node identification is more reliable than critical view of safety in difficult cholecystectomies

Ng, H. J., Nassar, A., Wysocki, A. P., Ahmed, Z. and Gil, I. C. (2021) Cystic lymph node identification is more reliable than critical view of safety in difficult cholecystectomies. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, 31(2), pp. 155-159. (doi: 10.1097/SLE.0000000000000900) (PMID:33782336)

Abstract

Background: The cystic lymph node (CLN) represents an anatomic safety marker and a surrogate marker of technique during laparoscopic cholecystectomy (LC). We aim to demonstrate the value of CLN in comparison to the critical view of safety (CVS) and study the effects of increasing difficulty on the 2 approaches. Methods: A prospective study of consecutive LC was conducted. Patient demographics, type of admission, clinical presentation, operative difficulty grade, visualization of CLN, identification of CVS, operative time, and complications were recorded and analyzed. Results: Of 393 LCs, half of the admissions were emergencies. Thirty-four percent had obstructive jaundice or acute cholecystitis. The CLN was visually identified in 81.7% with a small difference between operative difficulty grades 1 to 3 versus 4 to 5. Although CVS was unachievable in 62 patients, 43 (69.4%) still had an identifiable CLN. The median operating time was 68 minutes with 1 mortality but no conversions or intraoperative complications. Conclusions: Identifying the CLN during LC could compliment the CVS in avoiding major ductal injury. Dissecting lateral to the CLN to commence the process of displaying the cystic pedicle structures may be a strategy in safely achieving the CVS. During the more difficult LC where displaying the CVS is impossible, the CLN may be the key anatomic landmark.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nassar, Mr Ahmad
• Authors: Ng, H. J., Nassar, A., Wysocki, A. P., Ahmed, Z., and Gil, I. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 1530-4515
• ISSN (Online): 1534-4908
• Copyright Holders: Copyright © 2021 Wolters Kluwer Health, Inc.
• First Published: First published in Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 31(2):155-159
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher