Initiating dissection to achieve the critical view of safety in minimally invasive cholecystectomy: A retrospective comparison of lower-end-first, Calot’s triangle-first and salvage approaches

Anupam Gupta

doi:10.4103/jmas.jmas_321_25

April 13, 2026Journal of Minimal Access SurgeryOpen Access

Initiating dissection to achieve the critical view of safety in minimally invasive cholecystectomy: A retrospective comparison of lower-end-first, Calot’s triangle-first and salvage approaches

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Key Points

This research aims to evaluate different dissection strategies for achieving the critical view of safety in cholecystectomy.
Conducted a retrospective comparison of lower-end-first, Calot's triangle-first, and substantiated cholecystectomy approaches.
Analyzed patient outcomes regarding the achievement of the critical view and safety metrics.
Lower-end-first and Calot's triangle-first techniques consistently achieved the critical view safely.
When standard methods failed due to inflammation, subtotal cholecystectomy was a successful alternative with no risk of bile duct injury (BDI).

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Implication

Retrospective comparison reveals effective dissection methods in achieving safety during cholecystectomy, suggesting effective options for complex cases.

Abstract

Both lower-end-first and Calot's triangle-first dissection strategies reliably achieve the critical view and allow the safe completion of LC. When inflammation prevents these approaches, domedown or subtotal cholecystectomy provides a safe bailout, with no BDI risk.

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Anupam Gupta (2026) studied this question.

synapsesocial.com/papers/69df2b04e4eeef8a2a6aff94 https://doi.org/10.4103/jmas.jmas_321_25

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Initiating dissection to achieve the critical view of safety in minimally invasive cholecystectomy: A retrospective comparison of lower-end-first, Calot’s triangle-first and salvage approaches

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Initiating dissection to achieve the critical view of safety in minimally invasive cholecystectomy: A retrospective comparison of lower-end-first, Calot’s triangle-first and salvage approaches

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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