BACKGROUND: At laparoscopic cholecystectomy, most surgeons have adopted the operative approach where the 'critical view of safety' (CVS) is achieved prior to dividing the cystic duct and artery. This prospective study evaluated whether an adequate critical view was achieved by scoring standardized intra-operative photographic views and whether there were other factors that might impact on the ability to obtain an adequate critical view. METHODS: One hundred consecutive patients undergoing a laparoscopic cholecystectomy were studied. At each operation, two photographs were taken. Two independent experienced hepatobiliary surgeons scored the photographs on whether a critical view of safety was achieved. Inter-observer agreement was calculated using the weighted kappa coefficient. The Cochran-Mantel-Haenszel test was used to analyse the scores with potential confounding clinical factors. RESULTS: The kappa coefficient for adequate display of the cystic duct and artery was 0.49; 95% confidence interval (CI) 0.33 to 0.64; P = 0.001. No bias was detected in the overall scorings between the two observers (χ(2) 1.33; P = 0.312). Other clinical factors including surgeon seniority did not alter the outcome [odds ratio (OR) 0.902; 95% confidence interval 0.622 to 1.264]. CONCLUSION: Heightened awareness of the CVS through mandatory documentation may improve both trainee and surgeon technique.
BACKGROUND: At laparoscopic cholecystectomy, most surgeons have adopted the operative approach where the 'critical view of safety' (CVS) is achieved prior to dividing the cystic duct and artery. This prospective study evaluated whether an adequate critical view was achieved by scoring standardized intra-operative photographic views and whether there were other factors that might impact on the ability to obtain an adequate critical view. METHODS: One hundred consecutive patients undergoing a laparoscopic cholecystectomy were studied. At each operation, two photographs were taken. Two independent experienced hepatobiliary surgeons scored the photographs on whether a critical view of safety was achieved. Inter-observer agreement was calculated using the weighted kappa coefficient. The Cochran-Mantel-Haenszel test was used to analyse the scores with potential confounding clinical factors. RESULTS: The kappa coefficient for adequate display of the cystic duct and artery was 0.49; 95% confidence interval (CI) 0.33 to 0.64; P = 0.001. No bias was detected in the overall scorings between the two observers (χ(2) 1.33; P = 0.312). Other clinical factors including surgeon seniority did not alter the outcome [odds ratio (OR) 0.902; 95% confidence interval 0.622 to 1.264]. CONCLUSION: Heightened awareness of the CVS through mandatory documentation may improve both trainee and surgeon technique.
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Authors: Niall O'Connor; Michael Sugrue; Conor Melly; Gearoid McGeehan; Magda Bucholc; Aileen Crawford; Paul O'Connor; Fikri Abu-Zidan; Imtiaz Wani; Zsolt J Balogh; Vishal G Shelat; Giovanni D Tebala; Belinda De Simone; Hani O Eid; Mircea Chirica; Gustavo P Fraga; Salomone Di Saverio; Edoardo Picetti; Luigi Bonavina; Marco Ceresoli; Andreas Fette; Boris Sakakushe; Emmanouil Pikoulis; Raul Coimbra; Richard Ten Broek; Andreas Hecker; Ari Leppäniemi; Andrey Litvin; Philip Stahel; Edward Tan; Kaoru Koike; Fausto Catena; Michele Pisano; Federico Coccolini; Alison Johnston Journal: World J Emerg Surg Date: 2022-03-17 Impact factor: 5.469