How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy?

Bacon, Simon L.; Chintalapudi, Nikita; Anderson-Montoya, Brittany L.; Oommen, Bindhu; Tobben, Daniel; Pimentel, Manuel

doi:10.1007/s00464-016-4943-5

Cited by 55 publications

(46 citation statements)

References 21 publications

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“…The reported incidence of bile duct injury (CBDI) during LC ranges from 0.16% to 1.5%, and has not decreased over time. Stefanidis et al[37] studied how often surgeons resort to the consideration of the CVS during LC and their results were disappointed. Only 20% of observed surgeons achieved adequately the CVS during LC; that is, CVS criterion was not routinely used by majority of surgeons.…”

Section: Laparoscopic or Open Approachmentioning

confidence: 99%

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Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

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Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.

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Section: Laparoscopic or Open Approachmentioning

confidence: 99%

“…Only 20% of observed surgeons achieved adequately the CVS during LC; that is, CVS criterion was not routinely used by majority of surgeons. Furthermore, one-fourth of those who claimed to obtain the CVS did so inadequately[37]. …”

Section: Laparoscopic or Open Approachmentioning

confidence: 99%

Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

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“…Furthermore, the reluctance in adopting new techniques among surgeons is high, and the low incidence of BDI during LC makes it even harder for surgeons to find motivation to change their habits [19]. Interestingly, a study showed that even in hospitals in which the CVS is routinely used and operative notes report that the CVS had been obtained, about 25% of those who claimed to have obtained it did so inadequately [20]. This suggests that surgeons may not fully comprehend the details and the rationale behind the CVS and may for example confuse it with the infundibular technique [21].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon.

Bogacki¹,

Krzak²,

Gotfryd-Bugajska³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Common bile duct injury (CBDI) is a severe complication of laparoscopic cholecystectomy (LC). To minimize its occurrence, SAGES established the Safe Cholecystectomy Program (SCP) with 6 rules to follow during surgery. Aim: To assess the knowledge of SCP among European surgeons and their opinion on its usefulness. Material and methods: Data were gathered using questionnaires during surgical conferences in Poland and Denmark. The questionnaire asked about the surgeon's experience in cholecystectomy and the number of complications in the form of CBDI. It asked about the surgeon's opinion on the usefulness of SCP rules on a 10-point scale. A comparison between specialists and residents was performed. The study has been registered in the ClinicalTrials. gov-NCT03155321. Results: One hundred eighty-four questionnaires were gathered. One hundred fourteen (61.96%) specialists (72.8% male, mean age: 50 years) and 70 (38.04%) residents (56% male, mean age: 34 years) completed the questionnaire. Mean work experience was 22 years among specialists and 4.5 years among residents. A high percentage of specialists have experienced CBDI (46% vs. 17% of residents, p = 0.014). More specialists are familiar with the SCP than residents (49.3% vs. 21.7%, p = 0.021). Significant differences in the mean usefulness score were observed for three rules: rules 2 and 6 were found more useful by residents (mean score: 7.07 vs. 6.01, p = 0.025 and 8.70 vs. 8.27, p < 0.001), and rule 3 was found more useful by specialists (mean: 8.73 vs. 8.36, p < 0.001). Conclusions: The awareness of the SCP in Europe is low. Participants consider the rules of the SCP to be useful during surgery, although there are differences in the usefulness scores between the groups. An educational program to promote and further implement the SCP should be established.

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“…In addition, the consistency and accuracy of the CVS in practice has been documented as poor. [10][11][12][13] These studies point to the need for a mechanism to standardize and teach the CVS.…”

Section: Resultsmentioning

confidence: 99%

Live Quality Assurance: Using a Multimedia Messaging Service Group Chat to Instantly Grade Intraoperative Images

Sobba

Fernandez

McNatt

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: The technique for attaining photographic evidence of the critical view of safety (CVS) in laparoscopic cholecystectomy (LC) has previously been defined; however, the consistency, accuracy, and feasibility of CVS in practice is unknown. The aim of this study was to use an already established image sharing and grading system to determine the feasibility of timely feedback after sharing intraoperative images of the CVS and to evaluate if and how cholecystitis affects the ability to attain a CVS. STUDY DESIGN: We studied 193 laparoscopic cholecystectomies performed by 14 surgeons between August 2017 and January 2019. Anterior and posterior intraoperative CVS images were shared using a standard multimedia messaging system (MMS). Images were graded remotely by members of the group using an established scoring system, and their times to response and scores were recorded. Response data were analyzed for the ability to attain timely and consistent CVS scores. RESULTS: There were 74 urgent laparoscopic cholecystectomies for acute cholecystitis and 119 nonurgent cholecystectomies performed during the study period. Scoring of shared images occurred in less than 5 minutes, and peer review (mean 3 responses) showed agreement that was not significantly different. In patients with acute cholecystitis, a small but significant difference was observed between anterior and posterior image scoring agreement. CONCLUSIONS: An established image sharing and grading system for CVS can be used for real-time intraoperative feedback without increasing operative time or compromising private health information. The CVS is almost always attainable; however, decreases in CVS quality and grading agreement are observed in patients with acute cholecystitis.

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How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy?

Cited by 55 publications

References 21 publications

Acute calculous cholecystitis: Review of current best practices

Acute calculous cholecystitis: Review of current best practices

Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon.

Live Quality Assurance: Using a Multimedia Messaging Service Group Chat to Instantly Grade Intraoperative Images

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