“The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include:
(1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations
(2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury
(3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy
(4) proper gallbladder retraction
(5) safe use of various energy devices
(6) understanding the critical view of safety, including its doublet view and documentation
(7) awareness of various error traps (e.g., fundus first technique)
(8) use of various bailout strategies (e.g., subtotal cholecystectomy) in difficult gallbladder cases
(9) use of intraoperative imaging techniques (e.g., intraoperative cholangiogram) to ascertain correct anatomy
(10) understanding the concept of time-out.”

“Biliary injuries after LC can result in significant morbidity. The surgical team involved in LC should be aware of the concept of “culture of safety in cholecystectomy” (COSIC). This universal culture of safety should be routinely adopted by the whole surgical team during every case. The key components of the COSIC, summarised as “ABCD of a safe LC” include: (1) a clear understanding of relevant anatomy; (2) appropriate and timely use of bailout techniques; (3) obtaining CVS prior to division of cystic duct and artery in every case; (4) recognizing the importance of time-out; (5) use of intraoperative imaging; (6) obtaining a second opinion in difficult cases; and (7) importance of proper documentation.”

Gupta, V., & Jain, G. (2019). Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World journal of gastrointestinal surgery, 11(2), 62–84.