Iftikhar Muhammad, Shah Muhammad, Ullah Zia, Shakoor Haythem Abdul, Ullah Shahid
General Surgery Department, Hayatabad Medical Complex Peshawar, Peshawar, PAK.
Anatomy Department, Peshawar Institute of Medical Sciences, Peshawar, PAK.
Cureus. 2023 Aug 25;15(8):e44098. doi: 10.7759/cureus.44098. eCollection 2023 Aug.
Misidentification of anatomical structures is one of the most common causes of bile duct injury following laparoscopic cholecystectomy. Achieving Critical View of Safety (CVS) is a standard step in conducting safe cholecystectomy all over the world. In our institute, we achieve CVS via a unique technique called Triple One or 111 and find it very helpful and easy to achieve CVS. Moreover, the rate of conversion has also decreased while achieving CVS via this technique. The unique aspect of the Triple One technique is that by following this method, even new laparoscopic surgeons can achieve CVS very easily in difficult cases and, hence, it decreases the chances of vasculobiliary injury (VBI).
This study aimed to determine how effective the Triple One technique is in achieving CVS as well as in lessening the chances of VBI.
A total of 545 patients were admitted through the outpatient department, ranging in age from 30 to 70 years, with a mean of 50 years. The study comprised patients with American Society of Anaesthesiologists (ASA) I & II, acute and chronic cholecystitis, and symptomatic cholelithiasis. The study excluded patients with co-morbidities, prior abdominal procedures, and suspected complications. On the second postoperative day, all patients received their discharge papers and on the seventh postoperative day, follow-up was completed.
Successful gallbladder extraction using the Triple One technique was achieved in 540 (99%) cases. The other five (1%) cases converted to open cholecystectomy because of the difficult gallbladder anatomy and extensive scarring. No VBI or bile duct injury was noted. No mortality was recorded during the study period.
By incorporating CVS using the Triple One technique into our policies and curriculum, we may encourage safe cholecystectomy practices and prevent bile duct injuries.
解剖结构识别错误是腹腔镜胆囊切除术后胆管损伤最常见的原因之一。实现安全关键视野（CVS）是全球进行安全胆囊切除术的标准步骤。在我们研究所，我们通过一种名为“三一法”或“111法”的独特技术实现CVS，发现它对实现CVS非常有帮助且容易。此外，通过这种技术实现CVS时，中转率也有所下降。“三一法”的独特之处在于，遵循这种方法，即使是新的腹腔镜外科医生在困难病例中也能很容易地实现CVS，因此，它降低了血管胆管损伤（VBI）的几率。
本研究旨在确定“三一法”在实现CVS以及降低VBI几率方面的效果如何。
共有545例患者通过门诊入院，年龄在30至70岁之间，平均年龄50岁。该研究纳入了美国麻醉医师协会（ASA）分级为I级和II级、患有急性和慢性胆囊炎以及有症状胆结石的患者。该研究排除了患有合并症、既往有腹部手术史以及疑似并发症的患者。术后第二天，所有患者均收到出院文件，术后第七天完成随访。
使用“三一法”成功切除胆囊的有540例（99%）。另外5例（1%）因胆囊解剖结构困难和广泛瘢痕形成而中转开腹胆囊切除术。未发现VBI或胆管损伤。研究期间无死亡记录。
通过将使用“三一法”实现CVS纳入我们的政策和课程中，我们可以鼓励安全的胆囊切除手术操作并预防胆管损伤。
