Factors Influencing the Achievement of the Critical View of Safety in Laparoscopic Cholecystectomy: A Prospective Observational Study in Yemen

Background The critical view of safety (CVS) is a critical technique to minimize the risk of bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC). This study evaluated the rate of CVS achievement and examined factors influencing its success. Methods This prospective study included 97 patients undergoing LC. Data on demographic characteristics, preoperative factors, surgical difficulty, and surgeon experience were collected. CVS achievement was assessed using Strasberg's criteria, and associated factors were analyzed. Results CVS was successfully achieved in 31 of 97 cases (32%), while it was not achieved in 66 cases (68%). Factors significantly associated with failure to achieve CVS included previous abdominal surgery (p = 0.024), prior endoscopic retrograde cholangiopancreatography (ERCP) (p = 0.024), acute cholecystitis (p = 0.024), and higher difficulty grades according to the modified Nassar scale (p < 0.001). Although there was no statistically significant difference in CVS achievement between specialists and residents (p = 0.223), specialists had a higher success rate (37.5%) compared to residents (28%). Achieving CVS was associated with shorter operative times (mean: 60 vs. 70 minutes, p < 0.001) and reduced use of postoperative drains (16.1% vs. 83.9%, p < 0.001). Importantly, no BDIs were observed. Conclusion Achieving CVS remains a challenge, particularly in complex cases and patients with prior abdominal interventions or acute inflammation. Enhanced surgical training, meticulous preoperative planning, and the use of adjunctive technologies may improve CVS success rates and contribute to safer outcomes in LC.