Comparative analysis of reliability and clinical effects of the critical view of safety approach used in laparoscopic cholecystectomy in the pediatric population



With the increase in indications for cholecystectomy in children, the frequency of laparoscopic cholecystectomy procedures and related problems has increased. The Critical View of Safety (CVS) is the target-specific method for identifying the cystic duct during laparoscopic cholecystectomy to prevent common bile duct injury. We hypothesize that the use of CVS is reliable in the pediatric population.


Data of 91 patients under 18 years of age who underwent elective laparoscopic cholecystectomy were retrospectively analyzed. Patients were divided into two groups depending on whether CVS was applied. The descriptive characteristics and complications of the two groups were compared.


CVS was applied to 41 patients. When the groups were compared in terms of operation time, postoperative length of stay, idiopathic gallbladder perforation, dropping stone, and presence of surgical site infection, no statistical significant difference was found. However, the time to start oral feeding was shorter in CVS group (p = 0.01).


We believe CVS is a reliable method to ensure safe cystic channel identification in the pediatric population. New studies are warranted on the effectiveness of CVS for safely performing laparoscopic cholecystectomy in children, as the procedure is being performed more frequently in the pediatric population.

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Author information




Şeref Selçuk Kılıç: participated in the planning, conducting of the study, interpretation of data, collection and writing of manuscript. Önder Özden and Selcan Türker Çolak: participated in the collection and interpretation of the study data. All the authors approved the final submitted draft of this manuscript.

Corresponding author

Correspondence to Şeref Selçuk Kılıç.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

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The authors have no conflicts of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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The necessary permission to conduct the research was obtained from the Non-Invasive Research Ethics Committee (86, 8/3/2019, No:32).

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Informed consent was obtained from the patients’ parents.

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Kılıç, Ş.S., Özden, Ö. & Çolak, S.T. Comparative analysis of reliability and clinical effects of the critical view of safety approach used in laparoscopic cholecystectomy in the pediatric population. Pediatr Surg Int (2021).

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  • Gallbladder
  • Laparoscopic cholecystectomy
  • Common bile duct injury
  • Pediatric