{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:48:50Z","timestamp":1792194530494,"version":"4.4.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 Chi-squared test were used to identify independent predictors of CVS achievement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The rate of CVS achievement in this study was 69.6% among consultants and 60.0% among residents. Logistic regression identified ASA grade I (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031), emergency surgery (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), acute cholecystitis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031), and non-HPB surgeons (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) 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 &amp;amp; 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1661510","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:27:38Z","timestamp":1758778058000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Patient and surgeon predictors of achieving the critical view of safety in laparoscopic cholecystectomy: a prospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Rami","family":"Addasi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana","family":"Al-Sabe\u2019","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kareem","family":"AlRawabdeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rand","family":"Abu-Zayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Alaarag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Marcelo A. 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S.","family":"El Muhtaseb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salam","family":"Daradkeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"B1","first-page":"341","article-title":"Erich M\u00fche and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time","volume":"2","author":"Litynski","year":"1998","journal-title":"JSLS"},{"key":"B2","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1001\/archsurg.1992.01420080051008","article-title":"Laparoscopic cholecystectomy: the new \u201cgold standard\u201d?","volume":"127","author":"Soper","year":"1992","journal-title":"Arch Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1002\/bjs.5266","article-title":"Bile duct injury in the era of laparoscopic cholecystectomy","volume":"93","author":"Connor","year":"2006","journal-title":"Br J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"CD006231","DOI":"10.1002\/14651858.CD006231","article-title":"Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis","volume":"4","author":"Keus","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"B5","first-page":"101","article-title":"An analysis of the problem of biliary injury during laparoscopic cholecystectomy","volume":"180","author":"Strasberg","year":"1995","journal-title":"J Am Coll Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1002\/bjs.1800811225","article-title":"Risk factors for bile duct injury in laparoscopic cholecystectomy: analysis of 49 cases","volume":"81","author":"Go","year":"1994","journal-title":"Br J Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1001\/archsurg.141.12.1207","article-title":"Iatrogenic bile duct injury: a population-based study of 152,776 cholecystectomies in the Swedish inpatient registry","volume":"141","author":"Waage","year":"2006","journal-title":"Arch Surg"},{"key":"B8","article-title":"Bile duct repair","volume-title":"StatPearls","author":"Seeras","year":"2023"},{"key":"B9","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1097\/SLA.0000000000002054","article-title":"The critical view of safety: why it is not the only method of ductal identification within the standard of care in laparoscopic cholecystectomy","volume":"265","author":"Strasberg","year":"2017","journal-title":"Ann Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1097\/01.SLA.0000060680.92690.E9","article-title":"Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective","volume":"237","author":"Way","year":"2003","journal-title":"Ann Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/jhbp.515","article-title":"Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)","volume":"25","author":"Yokoe","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e2022.00093","DOI":"10.4293\/JSLS.2022.00093","article-title":"Intraoperative cholangiography in laparoscopic cholecystectomy: a systematic review and meta-analysis","volume":"27","author":"Hall","year":"2023","journal-title":"JSLS"},{"key":"B13","doi-asserted-by":"publisher","first-page":"63","DOI":"10.3109\/13645709509152757","article-title":"Is laparoscopic cholecystectomy possible without video technology?","volume":"4","author":"Nassar","year":"1995","journal-title":"Minim Invasive Ther"},{"key":"B14","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s00464-018-6281-2","article-title":"Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy","volume":"33","author":"Griffiths","year":"2019","journal-title":"Surg Endosc"},{"key":"B15","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.jamcollsurg.2013.11.003","article-title":"A simple effective method for generation of a permanent record of the critical view of safety during laparoscopic cholecystectomy by intraoperative \u201cdoublet\u201d photography","volume":"218","author":"Sanford","year":"2014","journal-title":"J Am Coll Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"3698","DOI":"10.1007\/s00464-020-07852-6","article-title":"The critical view of safety during laparoscopic cholecystectomy: Strasberg yes or no? 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