When is it safe to continue laparoscopically?

Abstract

Complications of laparoscopic cholecystectomy can have significant morbidity and mortality. The failure to move forward in surgery, anatomical disorientation, and decreased visualization, whatever their cause, may affect the safety of cholecystectomy. The laparoscopic procedure is controversial in a surgical field of inflammation, fibrosis, and changes in the anatomy of the region. The indicators that enable us to continue with the laparoscopic cholecystectomy are: (1) anatomical knowledge of the region and its variations, (2) obtaining a critical view of safety (CVS) or as a primary alternative of the gallbladder-cystic junction, before tying and cutting any structure, (3) achieving intraoperative images, (4) performing maneuvers to improve surgical exposure, (5) consult for a second opinion, and (6) the adoption of alternative laparoscopic procedures (subtotal cholecystectomy, cholecystostomy) or conversion to laparotomy. A calm, reflective and shared responsibility attitude is essential for surgical decision-making for the development of a safety culture during cholecystectomy.