Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)

Go Wakabayashi, Yukio Iwashita, Taizo Hibi, Tadahiro Takada, Steven M. Strasberg, Horacio J. Asbun, Itaru Endo, Akiko Umezawa, Koji Asai, Kenji Suzuki, Yasuhisa Mori, Kohji Okamoto, Henry A. Pitt, Ho Seong Han, Tsann Long Hwang, Yoo Seok Yoon, Dong Sup Yoon, In Seok Choi, Wayne Shih Wei Huang, Mariano Eduardo GiménezO. James Garden, Dirk J. Gouma, Giulio Belli, Christos Dervenis, Palepu Jagannath, Angus C.W. Chan, Wan Yee Lau, Keng Hao Liu, Cheng Hsi Su, Takeyuki Misawa, Masafumi Nakamura, Akihiko Horiguchi, Nobumi Tagaya, Shuichi Fujioka, Ryota Higuchi, Satoru Shikata, Yoshinori Noguchi, Tomohiko Ukai, Masamichi Yokoe, Daniel Cherqui, Goro Honda, Atsushi Sugioka, Eduardo de Santibañes, Avinash Nivritti Supe, Hiromi Tokumura, Taizo Kimura, Masahiro Yoshida, Toshihiko Mayumi, Seigo Kitano, Masafumi Inomata, Koichi Hirata, Yoshinobu Sumiyama, Kazuo Inui, Masakazu Yamamoto

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail-out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail-out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouvière's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Original languageEnglish
Pages (from-to)73-86
Number of pages14
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume25
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Acute Cholecystitis
Tokyo
Laparoscopic Cholecystectomy
Guidelines
Safety
Fibrosis
Mobile Applications
Conversion to Open Surgery
Cystic Duct
Wounds and Injuries
Common Bile Duct
Cholecystectomy
Bile Ducts
Cicatrix
Inflammation

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology

Cite this

Tokyo Guidelines 2018 : surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). / Wakabayashi, Go; Iwashita, Yukio; Hibi, Taizo; Takada, Tadahiro; Strasberg, Steven M.; Asbun, Horacio J.; Endo, Itaru; Umezawa, Akiko; Asai, Koji; Suzuki, Kenji; Mori, Yasuhisa; Okamoto, Kohji; Pitt, Henry A.; Han, Ho Seong; Hwang, Tsann Long; Yoon, Yoo Seok; Yoon, Dong Sup; Choi, In Seok; Huang, Wayne Shih Wei; Giménez, Mariano Eduardo; Garden, O. James; Gouma, Dirk J.; Belli, Giulio; Dervenis, Christos; Jagannath, Palepu; Chan, Angus C.W.; Lau, Wan Yee; Liu, Keng Hao; Su, Cheng Hsi; Misawa, Takeyuki; Nakamura, Masafumi; Horiguchi, Akihiko; Tagaya, Nobumi; Fujioka, Shuichi; Higuchi, Ryota; Shikata, Satoru; Noguchi, Yoshinori; Ukai, Tomohiko; Yokoe, Masamichi; Cherqui, Daniel; Honda, Goro; Sugioka, Atsushi; de Santibañes, Eduardo; Supe, Avinash Nivritti; Tokumura, Hiromi; Kimura, Taizo; Yoshida, Masahiro; Mayumi, Toshihiko; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Sumiyama, Yoshinobu; Inui, Kazuo; Yamamoto, Masakazu.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 25, No. 1, 01.01.2018, p. 73-86.

Research output: Contribution to journalArticle

Wakabayashi, G, Iwashita, Y, Hibi, T, Takada, T, Strasberg, SM, Asbun, HJ, Endo, I, Umezawa, A, Asai, K, Suzuki, K, Mori, Y, Okamoto, K, Pitt, HA, Han, HS, Hwang, TL, Yoon, YS, Yoon, DS, Choi, IS, Huang, WSW, Giménez, ME, Garden, OJ, Gouma, DJ, Belli, G, Dervenis, C, Jagannath, P, Chan, ACW, Lau, WY, Liu, KH, Su, CH, Misawa, T, Nakamura, M, Horiguchi, A, Tagaya, N, Fujioka, S, Higuchi, R, Shikata, S, Noguchi, Y, Ukai, T, Yokoe, M, Cherqui, D, Honda, G, Sugioka, A, de Santibañes, E, Supe, AN, Tokumura, H, Kimura, T, Yoshida, M, Mayumi, T, Kitano, S, Inomata, M, Hirata, K, Sumiyama, Y, Inui, K & Yamamoto, M 2018, 'Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 25, no. 1, pp. 73-86. https://doi.org/10.1002/jhbp.517
Wakabayashi, Go ; Iwashita, Yukio ; Hibi, Taizo ; Takada, Tadahiro ; Strasberg, Steven M. ; Asbun, Horacio J. ; Endo, Itaru ; Umezawa, Akiko ; Asai, Koji ; Suzuki, Kenji ; Mori, Yasuhisa ; Okamoto, Kohji ; Pitt, Henry A. ; Han, Ho Seong ; Hwang, Tsann Long ; Yoon, Yoo Seok ; Yoon, Dong Sup ; Choi, In Seok ; Huang, Wayne Shih Wei ; Giménez, Mariano Eduardo ; Garden, O. James ; Gouma, Dirk J. ; Belli, Giulio ; Dervenis, Christos ; Jagannath, Palepu ; Chan, Angus C.W. ; Lau, Wan Yee ; Liu, Keng Hao ; Su, Cheng Hsi ; Misawa, Takeyuki ; Nakamura, Masafumi ; Horiguchi, Akihiko ; Tagaya, Nobumi ; Fujioka, Shuichi ; Higuchi, Ryota ; Shikata, Satoru ; Noguchi, Yoshinori ; Ukai, Tomohiko ; Yokoe, Masamichi ; Cherqui, Daniel ; Honda, Goro ; Sugioka, Atsushi ; de Santibañes, Eduardo ; Supe, Avinash Nivritti ; Tokumura, Hiromi ; Kimura, Taizo ; Yoshida, Masahiro ; Mayumi, Toshihiko ; Kitano, Seigo ; Inomata, Masafumi ; Hirata, Koichi ; Sumiyama, Yoshinobu ; Inui, Kazuo ; Yamamoto, Masakazu. / Tokyo Guidelines 2018 : surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). In: Journal of Hepato-Biliary-Pancreatic Sciences. 2018 ; Vol. 25, No. 1. pp. 73-86.
@article{82d445b1f1cd47fd998fc8b983f0254f,
title = "Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)",
abstract = "In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail-out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail-out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouvi{\`e}re's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.",
author = "Go Wakabayashi and Yukio Iwashita and Taizo Hibi and Tadahiro Takada and Strasberg, {Steven M.} and Asbun, {Horacio J.} and Itaru Endo and Akiko Umezawa and Koji Asai and Kenji Suzuki and Yasuhisa Mori and Kohji Okamoto and Pitt, {Henry A.} and Han, {Ho Seong} and Hwang, {Tsann Long} and Yoon, {Yoo Seok} and Yoon, {Dong Sup} and Choi, {In Seok} and Huang, {Wayne Shih Wei} and Gim{\'e}nez, {Mariano Eduardo} and Garden, {O. James} and Gouma, {Dirk J.} and Giulio Belli and Christos Dervenis and Palepu Jagannath and Chan, {Angus C.W.} and Lau, {Wan Yee} and Liu, {Keng Hao} and Su, {Cheng Hsi} and Takeyuki Misawa and Masafumi Nakamura and Akihiko Horiguchi and Nobumi Tagaya and Shuichi Fujioka and Ryota Higuchi and Satoru Shikata and Yoshinori Noguchi and Tomohiko Ukai and Masamichi Yokoe and Daniel Cherqui and Goro Honda and Atsushi Sugioka and {de Santiba{\~n}es}, Eduardo and Supe, {Avinash Nivritti} and Hiromi Tokumura and Taizo Kimura and Masahiro Yoshida and Toshihiko Mayumi and Seigo Kitano and Masafumi Inomata and Koichi Hirata and Yoshinobu Sumiyama and Kazuo Inui and Masakazu Yamamoto",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/jhbp.517",
language = "English",
volume = "25",
pages = "73--86",
journal = "Journal of Hepato-Biliary-Pancreatic Sciences",
issn = "1868-6974",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - Tokyo Guidelines 2018

T2 - surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)

AU - Wakabayashi, Go

AU - Iwashita, Yukio

AU - Hibi, Taizo

AU - Takada, Tadahiro

AU - Strasberg, Steven M.

AU - Asbun, Horacio J.

AU - Endo, Itaru

AU - Umezawa, Akiko

AU - Asai, Koji

AU - Suzuki, Kenji

AU - Mori, Yasuhisa

AU - Okamoto, Kohji

AU - Pitt, Henry A.

AU - Han, Ho Seong

AU - Hwang, Tsann Long

AU - Yoon, Yoo Seok

AU - Yoon, Dong Sup

AU - Choi, In Seok

AU - Huang, Wayne Shih Wei

AU - Giménez, Mariano Eduardo

AU - Garden, O. James

AU - Gouma, Dirk J.

AU - Belli, Giulio

AU - Dervenis, Christos

AU - Jagannath, Palepu

AU - Chan, Angus C.W.

AU - Lau, Wan Yee

AU - Liu, Keng Hao

AU - Su, Cheng Hsi

AU - Misawa, Takeyuki

AU - Nakamura, Masafumi

AU - Horiguchi, Akihiko

AU - Tagaya, Nobumi

AU - Fujioka, Shuichi

AU - Higuchi, Ryota

AU - Shikata, Satoru

AU - Noguchi, Yoshinori

AU - Ukai, Tomohiko

AU - Yokoe, Masamichi

AU - Cherqui, Daniel

AU - Honda, Goro

AU - Sugioka, Atsushi

AU - de Santibañes, Eduardo

AU - Supe, Avinash Nivritti

AU - Tokumura, Hiromi

AU - Kimura, Taizo

AU - Yoshida, Masahiro

AU - Mayumi, Toshihiko

AU - Kitano, Seigo

AU - Inomata, Masafumi

AU - Hirata, Koichi

AU - Sumiyama, Yoshinobu

AU - Inui, Kazuo

AU - Yamamoto, Masakazu

PY - 2018/1/1

Y1 - 2018/1/1

N2 - In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail-out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail-out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouvière's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

AB - In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail-out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail-out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouvière's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

UR - http://www.scopus.com/inward/record.url?scp=85040732919&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040732919&partnerID=8YFLogxK

U2 - 10.1002/jhbp.517

DO - 10.1002/jhbp.517

M3 - Article

C2 - 29095575

AN - SCOPUS:85040732919

VL - 25

SP - 73

EP - 86

JO - Journal of Hepato-Biliary-Pancreatic Sciences

JF - Journal of Hepato-Biliary-Pancreatic Sciences

SN - 1868-6974

IS - 1

ER -