Achieving Critical View of Safety via a New Technique: The Triple One (111) Technique

Muhammad Iftikhar; Muhammad Shah; Zia Ullah; Haythem Abdul Shakoor; Shahid Ullah

doi:10.7759/cureus.44098

Achieving Critical View of Safety via a New Technique: The Triple One (111) Technique

Cureus. 2023 Aug 25;15(8):e44098. doi: 10.7759/cureus.44098. eCollection 2023 Aug.

Authors

Muhammad Iftikhar¹, Muhammad Shah¹, Zia Ullah², Haythem Abdul Shakoor¹, Shahid Ullah¹

Affiliations

¹ General Surgery Department, Hayatabad Medical Complex Peshawar, Peshawar, PAK.
² Anatomy Department, Peshawar Institute of Medical Sciences, Peshawar, PAK.

Abstract

Background: Misidentification of anatomical structures is one of the most common causes of bile duct injury following laparoscopic cholecystectomy. Achieving Critical View of Safety (CVS) is a standard step in conducting safe cholecystectomy all over the world. In our institute, we achieve CVS via a unique technique called Triple One or 111 and find it very helpful and easy to achieve CVS. Moreover, the rate of conversion has also decreased while achieving CVS via this technique. The unique aspect of the Triple One technique is that by following this method, even new laparoscopic surgeons can achieve CVS very easily in difficult cases and, hence, it decreases the chances of vasculobiliary injury (VBI).

Objective: This study aimed to determine how effective the Triple One technique is in achieving CVS as well as in lessening the chances of VBI.

Material and methods: A total of 545 patients were admitted through the outpatient department, ranging in age from 30 to 70 years, with a mean of 50 years. The study comprised patients with American Society of Anaesthesiologists (ASA) I & II, acute and chronic cholecystitis, and symptomatic cholelithiasis. The study excluded patients with co-morbidities, prior abdominal procedures, and suspected complications. On the second postoperative day, all patients received their discharge papers and on the seventh postoperative day, follow-up was completed.

Results: Successful gallbladder extraction using the Triple One technique was achieved in 540 (99%) cases. The other five (1%) cases converted to open cholecystectomy because of the difficult gallbladder anatomy and extensive scarring. No VBI or bile duct injury was noted. No mortality was recorded during the study period.

Conclusion: By incorporating CVS using the Triple One technique into our policies and curriculum, we may encourage safe cholecystectomy practices and prevent bile duct injuries.

Keywords: complications; cvs; lap chole; laparoscopic cholecystectomy; laparoscopic surgery; misidentification; post cholecystectomy bile duct injury; triple one technique; vasculobiliary.