{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T12:30:44Z","timestamp":1786710644487,"version":"build-2736575974"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surg Innov"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Laparoscopic cholecystectomy (LC) has revolutionised gallstone management. However, the incidence of bile duct injury (BDI) remains unchanged. Achieving the critical view of safety (CVS) is the standard endpoint of LC dissection to prevent BDI. This study aimed to identify preoperative, intraoperative, and novel predictors of CVS quality using intraoperative doublet photography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, single-centre observational study (March 2024\u2013January 2025) evaluated CVS achievement in patients undergoing elective LC. Experienced surgeons assessed anterior and posterior view photographs. We analysed predictors of CVS quality, including novel parameters such as critical angle, critical distance, and critical area ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 64 patients undergoing elective LC. CVS was satisfactory in 82.8% (53) and unsatisfactory in 17.2% (11) of the participants. Significant predictors of CVS quality included preoperative biochemical factors like erythrocyte sedimentation rate (OR: 4.06, 95% CI: 0.96-17.09,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .05) and alanine aminotransferase (OR: 5.48, 95% CI: 1.81-25.47,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02); radiological findings including stone impacted at gall bladder neck (OR: 9.52, 95% CI: 1.75-51.77,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .009); intraoperative variables such as modified Nassar grade (OR: 7.42, 95% CI: 1.72-32.00,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007) and Hartmann\u2019s pouch stone (OR: 4.47, 95% CI: 1.00\u2013 19.93,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04); and certain novel parameters including critical angle ratio anterior (AOR: 9.87, 95% CI: 1.1-83.12,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This observational study introduces simple metrics for objective CVS assessment using novel parameters such as critical angle, distance, and area to improve grading accuracy. These parameters may support artificial intelligence tools for intraoperative CVS quality assessment, promoting safer cholecystectomy and contributing to a standardised grading system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15533506261476209","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:25:55Z","timestamp":1786443955000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Critical View of Safety: New Predictors of Objective Assessment of Critical View of Safety in Laparoscopic cholecystectomy\u2014a Prospective Cohort Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8494-293X","authenticated-orcid":false,"given":"Ravi","family":"Gupta","sequence":"first","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5245-4456","authenticated-orcid":false,"given":"Aditya","family":"Gaurav","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Gupta","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama Shankar","family":"Rath","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dharmendra Kumar","family":"Pipal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukul","family":"Singh","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harikesh","family":"Yadav","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajnish","family":"Kumar","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish","family":"Kumar","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya Priyadarsani","family":"Bhuyan","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Prasad","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.02.053"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06842-0"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-010-0422-7"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7576"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.11.003"},{"key":"e_1_3_8_7_2","doi-asserted-by":"crossref","unstructured":"Liu P Hang X Li M Li J Xiaohua D. Retrospective evaluation of \u201ccritical view of safety\u201d in laparoscopic cholecystectomy. Research Square. https:\/\/www.researchsquare.com\/article\/rs-2892036\/v1. Published 2023. Accessed October 13 2025.","DOI":"10.21203\/rs.3.rs-2892036\/v1"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2021.04.017"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000004594"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000004351"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.74218"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-018-6281-2"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.103060"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-08093-3"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.76222"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2025.1661510"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1561769"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-07244-5"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.47717\/turkjsurg.2025.6505"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-2993-9"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-025-04642-4"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.4103\/jmas.jmas_165_18"}],"container-title":["Surgical Innovation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15533506261476209","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15533506261476209","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15533506261476209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:34:21Z","timestamp":1786707261000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15533506261476209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":21,"alternative-id":["10.1177\/15533506261476209"],"URL":"https:\/\/doi.org\/10.1177\/15533506261476209","relation":{},"ISSN":["1553-3506","1553-3514"],"issn-type":[{"value":"1553-3506","type":"print"},{"value":"1553-3514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"article-number":"15533506261476209"}}