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authors are to be congratulated for performing a mediumsized series of cholecystectomies for acute pathology with no bile duct injuries or leaks. We, too, fully endorse the practice of careful dissection in the triangle of Calot and achievement of the CVS before clipping and dividing any tubular structures. However, rather than viewing the CVS as a replacement for routine intraoperative cholangiography (IOC), we feel that the two safety measures complement each other. Sanjay and colleagues rightly argue that the large population-based studies often used to propagate routine IOC date from the pre-CVS era. 2,3 They continue to suggest that this protective effect is therefore not to be expected in modern surgical practice. In our point of view, this is an unlikely assertion. The CVS has been standard practice in the Netherlands for several years. A recent nationwide survey by our group confirmed that 98% of the Dutch surgeons use this technique. 4 Nonetheless, common bile duct (CBD) injuries remain a substantial problem in the Netherlands with an incidence that is estimated to be higher than the 0.5% often quoted in literature. 5 Referrals to the largest tertiary referral center for bile duct injury (BDI) in the Netherlands show no decreasing trend in the course of the past decade. 6 In our

The Critical View of Safety and Routine Intraoperative Cholangiography Complement Each Other as Safety Measures During Cholecystectomy