Work

Evaluating the Efficacy of Body-First Technique Compared to the Conventional Technique in Achieving a Critical View of Safety in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: Laparoscopic cholecystectomy (LAP-C) is the definitive treatment for symptomatic cholelithiasis, yet bile duct injury (BDI), primarily caused by anatomical misidentification, remains a formidable risk. The Critical View of Safety (CVS) achievement will prevent BDI, but its consistent attainment is technically demanding in inflamed or distorted anatomy. The body-first dissection technique has been proposed as an alternative approach to improve CVS achievement, though high-quality prospective evidence remains limited. This randomized controlled trial (RCT) was designed to systematically compare the two methods. METHODS: In this single-center, single-blinded RCT, 88 patients undergoing elective LAP-C were enrolled, after exclusion 80 patients were randomized into two groups: Group A (body-first technique) and Group B (conventional technique). The primary endpoints were the rate and quality of CVS achievement, and the duration of surgery. Secondary outcomes included intraoperative complications, recovery of gastrointestinal function, postoperative pain and nausea, inflammatory marker C-reactive protein (CRP) levels, and patient satisfaction assessed by the RAND-36 questionnaire at discharge, one month, and three months, and a p-value < 0.05 was considered statistically significant. RESULTS: The body-first approach demonstrated a higher rate of satisfactory CVS than the conventional approach (92.5% vs. 75.0%); however, the difference did not reach statistical significance on two-sided Fisher's exact testing (p=0.066). On multivariable logistic regression, the conventional technique was independently associated with significantly lower odds of CVS achievement (adjusted odds ratio (OR) 0.10, 95% CI 0.02-0.66, p=0.017). Operative duration was comparable between groups (76.3 vs. 84.8 minutes, p=0.438). After multivariable adjustment, surgical technique was not independently associated with operative duration (β = 6.54 minutes, SE=6.48; p=0.316), whereas increasing operative difficulty (Modified Nassar grade) was the only independent predictor of longer operative duration (β=13.32 minutes per one-grade increase, 95% CI 7.11-19.53; p < 0.001). The body-first group had significantly lower postoperative pain (OR: 5.74, 95% CI: 2.15-15.3, p=0.001), faster gastrointestinal recovery (OR: 3.12, 95% CI: 1.25-7.75, p=0.014). CONCLUSION: The body-first technique confers a higher rate of achieving CVS, promotes faster gastrointestinal recovery, and reduces postoperative pain compared to the conventional technique. The benefits in safety and recovery make it a favorable alternative to the conventional technique in LAP-C.

Source: Cureus

DOI: 10.7759/cureus.111629