NEW SAFETY MARKERS IN SAFE LAPAROSCOPIC CHOLECYSTECTOMY ravikgmc2004@gmail.com

315-03

NEW SAFETY MARKERS IN SAFE LAPAROSCOPIC CHOLECYSTECTOMY

6

India

Oral or Poster

Very few studies have identified novel markers for initiating dissection in laparoscopic cholecystectomy (LC), one being the R4U line, which uses Rouviere’s sulcus (RS), segment 4B base (4BB), and umbilical fissure (UF). Our study aims to define these landmarks along with new ones for commencing the dissection for safe LC.

This was an observational study conducted at AIIMS Gorakhpur, analysing video recordings of 130 LC (80 retrospective, 50 prospective). Key anatomical landmarks—cystic duct fold (CDF), artery to cystic duct (ACD), fat along the cystic artery (FCA), vascular pulsations of the common and right hepatic arteries (CHA & RHA) were documented. Data on Critical View of Safety (CVS) achievement, operative difficulty (Modified Nassar Grading Scale), and safety marker presence were recorded and analysed.

In 130 LC cystic lymph node (75.4%), CDF (66.2%), GB neck–cystic duct junction (66.2%), open type RS (38.5%) were identified as conventional safety markers. FCA (84.6%), CHA & RHA pulsation (72.3%) were new pre-dissection markers, and ACD (70.0%) as new post-dissection markers, were identified. CVS was achieved in 88.5% and has a strong association with Hartmann’s pouch, GB neck–cystic duct junction, RS, CDF, and FCA, with p-value of <0.05.

Along with other conventional markers few novel safety markers FCA, CDF, pulsation of RHA and CHA at the borders of HDL, help to guide for commencement of dissection. FCA emerges to be a new marker to start the dissection and to avoid unnecessary arterial injury and bleeding during the procedure.