Papagoras Dimitris, Douridas Gerasimos, Panagiotou Dimitrios, Toutouzas Konstantinos, Lykoudis Panagis, Charalabopoulos Alexandros, Korkolis Dimitrios, Alexiou Konstantinos, Sikalias Nikolaos, Lytras Dimitrios, Papavramidis Theodosios, Tepetes Konstantinos, Avgerinos Konstantinos, Arnaoutos Spyridon, Stamou Konstantinos, Lolis Evangelos, Zacharoulis Dimitrios, Zografos Georgios, Glantzounis Georgios
Surgical Department, General Hospital of Trikala, 421 00 Trikala, Greece.
Surgical Clinic Thriasio Hospital Elefsina, 190 18 Elefsina, Greece.
Medicina (Kaunas). 2024 Nov 29;60(12):1968. doi: 10.3390/medicina60121968.
: 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. 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. 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. 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.
腹腔镜胆囊切除术（LC）是西方世界普通外科中最常进行的手术。胆囊手术虽然大多数时候操作简单，但总是存在出现意外情况的可能性。尽管取得了进展，但胆总管损伤的发生率仍为0.2 - 0.4%，这给患者和外科医生带来了灾难性的后果。这主要是由于未能正确识别正常解剖结构。文献综述显示，在胆囊切除手术解剖学方面缺乏结构化知识。本研究的目的是为安全的腹腔镜和开放胆囊切除术开发一个具有通用解剖学语言的框架。希腊安全腹腔镜胆囊切除术类型学特别工作组对胆囊切除腹腔镜解剖学的文献进行了批判性综述。将结果与一项针对279例因单纯症状性胆结石疾病接受LC手术患者的临床研究结果进行了比较。确定了在安全关键视野（CVS）方法下LC过程中遇到的14个要素。在66%的研究病例中发现典型的血管-胆管蒂，其中一条胆囊管向外侧（或尾侧）分布，一条胆囊动脉向内侧（或头侧）分布，位于肝胆囊间隙的任何位置。制定了与正常情况和四种变异相对应的解剖示意图。所提出的认知解剖示意图简单总结了与正常情况相比可能出现的偏差。我们认为，正确应用CVS与胆囊切除手术解剖学的结构化知识之间的协同作用有助于外科医生安全处理非典型结构，并完成无血管-胆管损伤的腹腔镜或开放胆囊切除术。
