Recommendation for cholecystectomy protocol based on intraoperative ultrasound – a single-centre retrospective case-control study

Introduction
There is a strong need to make laparoscopic cholecystectomy as safe as possible, but sometimes complications in the form of bile duct and/or vascular injury occur. The safe plane of dissection can be precisely identified with intraoperative ultrasound, ensuring reduction of the complication rate to a minimum.

Aim
To evaluate the advantages of the cholecystectomy protocol based on the use of intraoperative ultrasound during laparoscopic and open cholecystectomy.

Material and methods
The study group consisted of 700 patients with symptomatic cholecystolithiasis, which was divided into two subgroups: with the critical view of safety only (312 patients) and with the critical view of safety + laparoscopic/open cholecystectomy ultrasound (388 patients). Laparoscopic cholecystectomy and conversion in patients from the second subgroup were performed under the control of intraoperative ultrasound.

Results
We did not observe any biliary complications, and the visualization of the common bile duct, the proper hepatic artery and the portal vein was obtained in every patient from the critical view of safety + laparoscopic/open cholecystectomy ultrasound group. The mean time of the operation was significantly shorter and the conversion, biliary injury and intraoperative bleeding rates were significantly lower in this group of patients.

Conclusions
Intraoperative ultrasound is a very efficient and safe method of guidance, and its use should be standard along with the critical view of safety during cholecystectomy.