Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO)
<i>Background and objectives</i>: Laparoscopic cholecystectomy (LC) is the most commonly performed operation in general surgery in the Western World. Gallbladder surgery, although most of the time simple, always offers the possibility of unpleasant surprises. Despite progress, the incide...
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| author | Dimitris Papagoras Gerasimos Douridas Dimitrios Panagiotou Konstantinos Toutouzas Panagis Lykoudis Alexandros Charalabopoulos Dimitrios Korkolis Konstantinos Alexiou Nikolaos Sikalias Dimitrios Lytras Theodosios Papavramidis Konstantinos Tepetes Konstantinos Avgerinos Spyridon Arnaoutos Konstantinos Stamou Evangelos Lolis Dimitrios Zacharoulis Georgios Zografos Georgios Glantzounis |
| author_facet | Dimitris Papagoras Gerasimos Douridas Dimitrios Panagiotou Konstantinos Toutouzas Panagis Lykoudis Alexandros Charalabopoulos Dimitrios Korkolis Konstantinos Alexiou Nikolaos Sikalias Dimitrios Lytras Theodosios Papavramidis Konstantinos Tepetes Konstantinos Avgerinos Spyridon Arnaoutos Konstantinos Stamou Evangelos Lolis Dimitrios Zacharoulis Georgios Zografos Georgios Glantzounis |
| author_sort | Dimitris Papagoras |
| collection | DOAJ |
| description | <i>Background and objectives</i>: Laparoscopic cholecystectomy (LC) is the most commonly performed operation in general surgery in the Western World. Gallbladder surgery, although most of the time simple, always offers the possibility of unpleasant surprises. Despite progress, the incidence of common bile duct injury is 0.2–0.4%, causing devastating implications for the patient and the surgeon. This is mainly due to the failure to identify the normal anatomy properly. The literature review reveals a lack of structured knowledge in the surgical anatomy of cholecystectomy. The aim of this study was to develop a framework with a common anatomical language for safe laparoscopic and open cholecystectomy. <i>Materials and Methods:</i> The Hellenic Task Force group on the typology for Safe Laparoscopic Cholecystectomy performed a critical review of the literature on the laparoscopic anatomy of cholecystectomy. The results were compared with those of a clinical study of 279 patients undergoing LC for uncomplicated symptomatic gallstone disease. <i>Results:</i> Fourteen elements encountered during LC under the critical view of safety (CVS) approach were determined. The typical vascular–biliary pedicle with one cystic duct distributed laterally (or caudally) and one cystic artery medially (or cranially) lying at any point of the hepatocystic space was found in 66% of the cases studied. Anatomical schemata were formulated corresponding to the norm and four variations. <i>Conclusions:</i> The proposed cognitive anatomical schemata summarize simply what one can expect in terms of deviation from the norm. We believe that the synergy between the correct application of the CVS and the structured knowledge of the surgical anatomy in cholecystectomy helps the surgeon to handle non-typical structures safely and to complete the laparoscopic or open cholecystectomy without vascular–biliary injuries. |
| format | Article |
| id | doaj-art-6b596d21801f4198bf57e2280bac640d |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-11-01 |
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| spelling | doaj-art-6b596d21801f4198bf57e2280bac640d2025-08-20T02:56:56ZengMDPI AGMedicina1010-660X1648-91442024-11-016012196810.3390/medicina60121968Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO)Dimitris Papagoras0Gerasimos Douridas1Dimitrios Panagiotou2Konstantinos Toutouzas3Panagis Lykoudis4Alexandros Charalabopoulos5Dimitrios Korkolis6Konstantinos Alexiou7Nikolaos Sikalias8Dimitrios Lytras9Theodosios Papavramidis10Konstantinos Tepetes11Konstantinos Avgerinos12Spyridon Arnaoutos13Konstantinos Stamou14Evangelos Lolis15Dimitrios Zacharoulis16Georgios Zografos17Georgios Glantzounis18Surgical Department, General Hospital of Trikala, 421 00 Trikala, GreeceSurgical Clinic Thriasio Hospital Elefsina, 190 18 Elefsina, GreeceSurgical Department, General Hospital of Trikala, 421 00 Trikala, Greece1st Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece4th Surgical Department, National and Kapodistrian University of Athens, University General Hospital Atttiko, 124 62 Athens, Greece1st Surgical Department, National and Kapodistrian University of Athens, Laiko Hospital, 115 27 Athens, GreeceDepartment of Surgical Oncology, Oncology Hospital Saint Savvas, 115 22 Athens, GreeceSurgical Department, Kentriki Kliniki, 106 80 Athens, GreeceSurgical Department, General Hospital Kalamata, 241 00 Kalamata, Greece2nd Surgical Department, General Hospital Papanikolaou, 570 10 Thessaloniki, Greece1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 546 36 Thessaloniki, GreeceDepartment of General Surgery, University Hospital Larisa, 413 34 Larisa, GreeceSurgical Department, General Hospital Bioclinic, 115 24 Athens, GreeceSurgical Department, General Hospital Sparta, 231 00 Sparta, GreeceSurgical Department, Privat Hospital Mitera, 151 23 Athens, GreeceHPB Unit, Department of Surgery, University Hospital of Ioannina, 455 00 Ioannina, GreeceDepartment of General Surgery, University Hospital Larisa, 413 34 Larisa, GreeceSurgical Department, General State Hospital Gennimatas, 115 27 Athens, GreeceHPB Unit, Department of Surgery, University Hospital of Ioannina, 455 00 Ioannina, Greece<i>Background and objectives</i>: Laparoscopic cholecystectomy (LC) is the most commonly performed operation in general surgery in the Western World. Gallbladder surgery, although most of the time simple, always offers the possibility of unpleasant surprises. Despite progress, the incidence of common bile duct injury is 0.2–0.4%, causing devastating implications for the patient and the surgeon. This is mainly due to the failure to identify the normal anatomy properly. The literature review reveals a lack of structured knowledge in the surgical anatomy of cholecystectomy. The aim of this study was to develop a framework with a common anatomical language for safe laparoscopic and open cholecystectomy. <i>Materials and Methods:</i> The Hellenic Task Force group on the typology for Safe Laparoscopic Cholecystectomy performed a critical review of the literature on the laparoscopic anatomy of cholecystectomy. The results were compared with those of a clinical study of 279 patients undergoing LC for uncomplicated symptomatic gallstone disease. <i>Results:</i> Fourteen elements encountered during LC under the critical view of safety (CVS) approach were determined. The typical vascular–biliary pedicle with one cystic duct distributed laterally (or caudally) and one cystic artery medially (or cranially) lying at any point of the hepatocystic space was found in 66% of the cases studied. Anatomical schemata were formulated corresponding to the norm and four variations. <i>Conclusions:</i> The proposed cognitive anatomical schemata summarize simply what one can expect in terms of deviation from the norm. We believe that the synergy between the correct application of the CVS and the structured knowledge of the surgical anatomy in cholecystectomy helps the surgeon to handle non-typical structures safely and to complete the laparoscopic or open cholecystectomy without vascular–biliary injuries.https://www.mdpi.com/1648-9144/60/12/1968surgical anatomy of cholecystectomytypologyvascular–biliary injurieslaparoscopicanatomical schematacritical view of safety |
| spellingShingle | Dimitris Papagoras Gerasimos Douridas Dimitrios Panagiotou Konstantinos Toutouzas Panagis Lykoudis Alexandros Charalabopoulos Dimitrios Korkolis Konstantinos Alexiou Nikolaos Sikalias Dimitrios Lytras Theodosios Papavramidis Konstantinos Tepetes Konstantinos Avgerinos Spyridon Arnaoutos Konstantinos Stamou Evangelos Lolis Dimitrios Zacharoulis Georgios Zografos Georgios Glantzounis Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO) Medicina surgical anatomy of cholecystectomy typology vascular–biliary injuries laparoscopic anatomical schemata critical view of safety |
| title | Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO) |
| title_full | Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO) |
| title_fullStr | Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO) |
| title_full_unstemmed | Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO) |
| title_short | Anatomical Schemata Revealed by the Critical View of Safety Approach: A Proposal of the Hellenic Task Force on the Typology of Safe Laparoscopic Cholecystectomy (HETALCHO) |
| title_sort | anatomical schemata revealed by the critical view of safety approach a proposal of the hellenic task force on the typology of safe laparoscopic cholecystectomy hetalcho |
| topic | surgical anatomy of cholecystectomy typology vascular–biliary injuries laparoscopic anatomical schemata critical view of safety |
| url | https://www.mdpi.com/1648-9144/60/12/1968 |
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