The segment IV approach: a useful method for achieving the critical view of safety during laparoscopic cholecystectomy in patients with anomalous bile duct

Shuichi Fujioka, Keigo Nakashima, Hiroaki Kitamura, Yuki Takano, Takeyuki Misawa, Yu Kumagai, Taigo Hata, Tadashi Akiba, Toru Ikegami, Katsuhiko Yanaga

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The critical view of safety (CVS) method can be achieved by avoiding vasculo-biliary injury resulting from misidentification during laparoscopic cholecystectomy (LC). Although achieving the CVS has become popular worldwide, there is no established standardized technique to achieve the CVS in patients with an anomalous bile duct (ABD). We recently reported our original approach for securing the CVS using a new landmark, the diagonal line of the segment IV of the liver (D-line). The D-line is an imaginary line that lies on the right border of the hilar plate. The cystic structure can be securely isolated along the D-line without any misidentification, regardless of the existence of an ABD. We named this approach the segment IV approach in LC. METHODS: In this study, we adopted the segment IV approach in patients with an ABD. RESULTS: From October 2015 to June 2020, 209 patients underwent LC using the segment IV approach. Among them, three (1.4%) were preoperatively diagnosed with an ABD. The branching point of the cystic duct was the posterior sectional duct, anterior sectional duct, or left hepatic duct in each patient. The CVS was achieved in all cases without any complications. CONCLUSION: It is a promising technique, especially even for patients with an ABD during LC.

Original languageEnglish
Pages (from-to)214
Number of pages1
JournalBMC Surgery
Volume20
Issue number1
DOIs
Publication statusPublished - Sep 23 2020

All Science Journal Classification (ASJC) codes

  • Surgery

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    Fujioka, S., Nakashima, K., Kitamura, H., Takano, Y., Misawa, T., Kumagai, Y., Hata, T., Akiba, T., Ikegami, T., & Yanaga, K. (2020). The segment IV approach: a useful method for achieving the critical view of safety during laparoscopic cholecystectomy in patients with anomalous bile duct. BMC Surgery, 20(1), 214. https://doi.org/10.1186/s12893-020-00873-x