Sebastian Maciej, Sebastian Agata, Rudnicki Jerzy
Department of General, Minimally Invasive, and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
Wideochir Inne Tech Maloinwazyjne. 2020 Dec;15(4):546-552. doi: 10.5114/wiitm.2020.100972. Epub 2020 Nov 18.
Even though the prevalence of bile duct injury (BDI) is nowadays lower than before and close to the era of open cholecystectomy, there is a strong need to make it even lower. B-SAFE is a group of five visual landmarks that may be used before dissection in the hepatocystic triangle for better orientation around the gallbladder. Another method is laparoscopic ultrasound (LUS), which enables confirmation of structures in the hepatoduodenal ligament and delineation of the safe plane of dissection.
To evaluate the use of B-SAFE and ultrasonographic landmarks during laparoscopic cholecystectomy in navigation around the gallbladder.
The study group consisted of 158 patients with symptomatic cholecystolithiasis. The methods of intraoperative orientation around the gallbladder attempted in every patient during laparoscopic cholecystectomy included B-SAFE and ultrasonographic landmarks.
The identification rate of ultrasonographic landmarks - the upper border of "Mickey Mouse" sign (MMS) (the equivalent of the Rouviere's sulcus), the bile duct, and the hepatic artery - was significantly higher in patients with body mass index ≥ 30 kg/m and fibrosis and chronic inflammation in the gallbladder neck than B-SAFE. LUS was also significantly more successful in the identification of the bile duct in the whole study group than B-SAFE. There were no significant differences according to the identification of the duodenum. The conversion rate was 2.6%, and we did not observe any BDI.
Visual landmarks defined in B-SAFE are not as reliable as ultrasonographic landmarks; thus, LUS should be taken into consideration in the first place as a method of navigation around the gallbladder.
尽管如今胆管损伤（BDI）的发生率低于以往，已接近开放胆囊切除术时代，但仍有强烈需求使其进一步降低。B-SAFE是一组五个视觉标志，可在肝胆囊三角区进行解剖前使用，以更好地确定胆囊周围的方位。另一种方法是腹腔镜超声（LUS），它能够确认肝十二指肠韧带内的结构并勾勒出安全的解剖平面。
评估在腹腔镜胆囊切除术中使用B-SAFE和超声标志来确定胆囊周围方位的情况。
研究组由158例有症状的胆囊结石患者组成。在腹腔镜胆囊切除术中，每位患者尝试的围绕胆囊进行术中定位的方法包括B-SAFE和超声标志。
在体重指数≥30 kg/m²且胆囊颈部有纤维化和慢性炎症的患者中，超声标志——“米老鼠”征（MMS）的上边界（相当于鲁维埃沟）、胆管和肝动脉的识别率显著高于B-SAFE。在整个研究组中，LUS对胆管的识别也明显比B-SAFE更成功。十二指肠的识别方面无显著差异。中转率为2.6%，且未观察到任何胆管损伤。
B-SAFE中定义的视觉标志不如超声标志可靠；因此，LUS应首先被视为一种确定胆囊周围方位的方法。
