Hepatobiliary and pancreatic surgery: critical view of safety: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: critical view of safety

Sample item

A trainee is taught the criteria to be met before clipping and dividing any structure during laparoscopic cholecystectomy. Which description fits the critical view of safety?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Triangle cleared, gallbladder off cystic plate, two structures entering

The critical view of safety requires a dissected hepatocystic triangle cleared of fat and fibrous tissue, the lower third of the gallbladder separated from the cystic plate of the liver, and exactly two structures, the cystic duct and artery, seen entering the gallbladder. It reduces bile duct injury.

Option by option

  • A. Gallbladder neck retracted and the cystic duct traced down to the duodenum

    Tracing the duct to the duodenum is not part of the standard technique.

  • B. Common bile duct traced and seen joining the cystic duct at the hilum

    Exposing the junction with the common bile duct is not required and is a risky dissection that promotes injury.

  • C. Intraoperative cholangiogram showing a normal, fully filled ductal tree

    Cholangiography is an optional adjunct and does not replace direct visual identification.

  • D. Triangle cleared, gallbladder off cystic plate, two structures entering (correct)

    Correct. These three elements together confirm that only the cystic duct and artery remain.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Triangle cleared, gallbladder off cystic plate, two structures entering. The critical view of safety requires a dissected hepatocystic triangle cleared of fat and fibrous tissue, the lower third of the gallbladder separated from the cystic plate of the liver, and exactly two structures, the cystic duct and artery, seen entering the gallbladder.

Why is "Gallbladder neck retracted and the cystic duct traced down to the duo…" not the answer?

Tracing the duct to the duodenum is not part of the standard technique.

Why is "Common bile duct traced and seen joining the cystic duct at the hilum" not the answer?

Exposing the junction with the common bile duct is not required and is a risky dissection that promotes injury.

Why is "Intraoperative cholangiogram showing a normal, fully filled ductal tr…" not the answer?

Cholangiography is an optional adjunct and does not replace direct visual identification.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: critical view of safety in General Surgery. It reduces bile duct injury.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: critical view of safety?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.