A perspective on the critical view of safety in laparoscopic cholecystectomy

Steven M. Strasberg


The critical view of safety (CVS) technique is a means of target identification, the targets being the cystic duct and artery. It was introduced more than 20 years ago in an attempt to reduce the rising incidence of biliary injuries. CVS is based on a method of anatomic iden-tification in open cholecystectomy. The three elements of CVS are to clear the hepatocystic triangle of fat and fibrous tissue, to take the lower part of the gallbladder off the cystic plate and to see that two and only two structures are entering the gallbladder. There is good evidence that CVS identification is effective in preventing biliary injury. Photodocumentation is possible and should be encouraged.