LAUSR

Study Objective The objective of this video is to demonstrate critical views in gynecologic surgery with the finality of decreasing inadvertent injury to vascular and genitourinary structures. Through this video, we will highlight these critical views when the risk of injury to important surrounding anatomic structures is high, and pathology that causes anatomic distortion is present. Our video emphasizes the importance of achieving these views before proceeding to the next step of the procedure. Design In general surgery, the rise of laparoscopic cholecystectomy was associated to a higher incidence of common bile duct injuries when compared to open. This was attributed to the common bile duct being mistakenly identified as the cystic duct. This injury was so common it was named “classical injury”. Subsequently, a “Critical view of safety” was described by identifying key anatomic landmarks and isolating key structures. If these landmarks were not isolated and key structures identified, the procedure would be halted until deemed safe to proceed. We adapted these concepts of “culture of safety” to gynecologic surgery and identified key anatomic landmarks and structures, in various scenarios, that could prevent genitourinary and vascular injury. The steps to identification and safety views are described in this video. Setting Academic medical center. Patients or Participants Surgical footage. Interventions Establish critical views in gynecologic surgery. Measurements and Main Results N/A Conclusion Critical views have been used in the field of General Surgery to minimize injury to the common bile duct during laparoscopic cholecystectomy, with observational literature supporting that these critical views have led to a decrease in inadvertent injury. Our goal with this video is to adopt this concept of “culture of safety” to gynecologic surgery by identifying views of safety that can minimizing operative complications.