ORIGINAL RESEARCH article
Front. Surg.
Sec. Visceral Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1661510
This article is part of the Research TopicAdvancing Benign Surgery: Techniques, Outcomes, and Educational InnovationsView all 10 articles
Patient and Surgeon Predictors of Achieving the Critical View of Safety in Laparoscopic Cholecystectomy: A Prospective Cohort Study
Provisionally accepted
Rami Addasi1*
Lana Al-Sabe1Kareem Alrawabdeh2Rand Abu-Zayed1Abdallah Alaarag3Marcelo Ribeiro Jr.4Ahmed Hazem Helmy5M S ElMuhtaseb1Salam Daradkeh1- 1Department of General Surgery, The University of Jordan School of Medicine, Amman, Jordan
- 2The University of Jordan School of Medicine, Amman, Jordan
- 3HCA Florida Healthcare, Davie, United States
- 4University of Maryland, College Park, United States
- 5Theodor Bilharz Research Institute, Giza, Egypt
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The Critical View of Safety (CVS) is a cornerstone of safe laparoscopic cholecystectomy (LC), aimed at minimizing the risk of bile duct injury (BDI). However, consistent achievement of CVS remains a challenge in surgical practice. The primary outcome of this study was to assess the rate of CVS achievement and to identify patient, disease and surgeon related predictors.A prospective cohort of 150 patients undergoing LC was analyzed. Demographic data, preoperative risk factors, intraoperative variables, and surgeon characteristics were examined. CVS assessment was performed using Strasberg's criteria. Binary logistic regression and Chisquared test were used to identify independent predictors of CVS achievement.The rate of CVS achievement in this study was 69.6% among consultants and 60.0% among residents. Logistic regression identified ASA grade I (p=0.031), emergency surgery (p=0.01), acute cholecystitis( p=0.031), and non-HPB surgeons (p<0.001) were associated with higher rate of CVS achievement. The higher rate of CVS achievement among non-HPB surgeons may reflect differences in case complexity, documentation practices & stricter adherence to protocols. Other factors including level of surgeon experience, Tokyo severity grade, intraoperative Nassar difficulty grading scale, age, male gender, BMI, diabetes mellitus and clinical frailty score were not significant.There were zero cases of bile duct injury in this study, precluding analysis of CVS failure impact on BDI.Both preoperative and intraoperative factors can influence a surgeon's ability to achieve CVS. In our study, lower ASA grade, emergency cholecystectomies, acute cholecystitis and operations performed by non-HPB surgeons were associated with a higher likelihood of achieving CVS. Standardized protocols and structured training may help improve CVS documentation across practice settings.
Keywords: laparoscopic cholecystectomy, Critical view of safety, Calot's triangle, Bile duct injury, Intraoperative cholangiography, Nassar Difficulty Grading Scale, Tokyo guidelines, acute cholecystitis
Received: 07 Jul 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Addasi, Al-Sabe, Alrawabdeh, Abu-Zayed, Alaarag, Ribeiro Jr., Helmy, ElMuhtaseb and Daradkeh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rami Addasi, Department of General Surgery, The University of Jordan School of Medicine, Amman, Jordan
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