Open Access Technique to Create Pneumoperitoneum and Use of ‘critical View of Safety’ As the Safest Way to Perform Laparoscopic Cholecystectomy

Konstantinos G Tsalis, PhD, George X Vrakas, MD, Zambia Koukouritaki, MD, George E Roidos, MD, Stavros Kalfadis, PhD, Konstantinos Bluchos, MD, Emmanouil C Christoforidis, PhD, Charalampos N Lazaridis, PhD. D’ Surgical Department Aristotles University of Thessaloniki, Greece

Introduction: The study aims to evaluate the use of “open access”(OA) technique to create pneumoperitoneum and “critical view of safety”(CVS) for the prevention of complications during laparoscopic cholecystectomy(LC) for cholelithiasis.
Results: Five hundred forty-seven laparoscopic cholecystectomies performed between January 2000 and January 2010 were reviewed. The first author was involved in all the operations, either by performing, or assisting in them. Eighty two patients had previous lower abdominal operations (43 appendectomies, 10 hysterectomies, 22 cesarian sections, 4 ovarian cysts and 3 laparoscopies). Five patients had upper abdominal operations (1 Heller myotomy, 2 gastrectomies, 1 vagotomy and 1 right hemicolectomy). Pneumoperitoneum was created through a 10mm supra or infra umbilical incision using a Hasson’s reusable trocar. Intraoperative cholangiography was performed in 6 patients. Thirty seven patients had acute cholecystitis, eleven patients had gallbladder empyema and five hydrops. CVS was achieved in 531/547(97%) patients. Where CVS was not possible, the operation was completed open. No bile duct injury or other mechanical complication occurred in this series.
Conclusion: The use of OA and CVS is a very safe way to avoid complications during LC.