Practice Evaluation of Safe Laparoscopic Cholecystectomy Techniques Among Surgeons in North Central Nigeria

Laparoscopic cholecystectomy is now the gold standard for treating symptomatic gallstone disease, yet bile duct injury, a potentially devastating complication, continues to occur at higher rates in low-resource settings where training and equipment quality are variable. This study evaluates knowledge and application of safe laparoscopic cholecystectomy techniques, particularly the Critical View of Safety (CVS), among practicing surgeons in North Central Nigeria. A cross-sectional survey of 65 general surgeons from FCT Abuja, Benue, Kogi, Nasarawa, Niger, and Plateau states was conducted using a validated structured questionnaire. Knowledge of CVS principles, laparoscopic equipment availability, training background, and self-reported complication rates were assessed. Awareness of the Critical View of Safety concept was high (81%), but self-reported consistent application was only 54%. Lack of high-definition laparoscopic stacks and suboptimal training frequency were identified as the primary barriers to safe technique application. Bile duct injury rates were estimated by surgeons at 0.8%, above internationally reported benchmarks. The study recommends mandatory laparoscopic skills training incorporating CVS principles in all surgical residency programs, procurement of appropriate equipment at surgical training centers, and establishment of a North Central Nigeria regional laparoscopic surgery skills laboratory. Keywords: laparoscopic cholecystectomy, bile duct injury, critical view of safety, North Central Nigeria, surgical technique