Taizo Hibi1, Yukio Iwashita2, Tetsuji Ohyama3, Goro Honda4, Masahiro Yoshida5, Tadahiro Takada6, Ho-Seong Han7, Tsann-Long Hwang8, Satoshi Shinya4, Kenji Suzuki9, Akiko Umezawa10, Yoo-Seok Yoon7, In-Seok Choi11, Wayne Shih-Wei Huang12, Kuo-Hsin Chen13, Fumihiko Miura6, Manabu Watanabe14, Yuta Abe1, Takeyuki Misawa15, Yuichi Nagakawa16, Dong-Sup Yoon17, Jin-Young Jang18, Hee Chul Yu19, Keun Soo Ahn20, Song Cheol Kim21, In Sang Song22, Ji Hoon Kim23, Sung Su Yun24, Seong Ho Choi25, Yi-Yin Jan8, Shyr-Ming Sheen-Chen26, Yan-Shen Shan27, Chen-Guo Ker28, De-Chuan Chan29, Cheng-Chung Wu30, Naoyuki Toyota31, Ryota Higuchi32, Yoshiharu Nakamura33, Yoshiaki Mizuguchi34, Yutaka Takeda35, Masahiro Ito36, Shinji Norimizu37, Shigetoshi Yamada38, Naoki Matsumura39, Junichi Shindoh40, Hiroki Sunagawa41, Takeshi Gocho42, Hiroshi Hasegawa43, Toshiki Rikiyama44, Naohiro Sata45, Nobuyasu Kano46, Seigo Kitano47, Hiromi Tokumura39, Yuichi Yamashita48, Goro Watanabe49, Kunitoshi Nakagawa50, Taizo Kimura10, Tatsuo Yamakawa51, Go Wakabayashi52, Itaru Endo53, Masaru Miyazaki54, Masakazu Yamamoto28. 1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan. 3. Department of Clinical Statistics and Data Management, Oita University Faculty of Medicine, Oita, Japan. 4. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. 5. Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Chiba, Japan. 6. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 7. Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea. 8. Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan. 9. Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan. 10. Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan. 11. Department of Surgery, Konyang University Hospital, Daejeon, Korea. 12. Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan. 13. Department of Surgery and Department of Electrical Engineering, Far-Eastern Memorial Hospital and Yuan Ze University, New Taipei City, Tauyuan, Taiwan. 14. Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan. 15. Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan. 16. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 17. Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea. 18. Department of Surgery, Seoul National University Hospital, Seoul, Korea. 19. Department of Surgery, Chonbuk National University Hospital, Jeonju, Korea. 20. Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. 21. Department of Surgery, University of Ulsan College of Medicine & Asan Medical Center, Seoul, Korea. 22. Department of Surgery, Chungnam National University Hospital, Daejeon, Korea. 23. Department of Surgery, Eulji University Hospital, Daejeon, Korea. 24. Department of Surgery, Yeungnam University, Daegu, Korea. 25. Department of Surgery, Sungkyunkwan University, Seoul, Korea. 26. Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 27. Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan. 28. Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan. 29. Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 30. Department of Surgery, Taicuhg-Veterans General Hospital, Taichung, Taiwan. 31. Department of Surgery, Musashino Tokushukai Hospital, Tokyo, Japan. 32. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 33. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. 34. Department of Surgery, Nippon Medical School, Tokyo, Japan. 35. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan. 36. Department of General and Pancreatic Surgery, Quality and Safety in Healthcare, Fujita Health University, Aichi, Japan. 37. Department of Surgery, Nagoya Daini Red Cross Hospital, Aichi, Japan. 38. Department of Surgery, Kameda Medical Center, Chiba, Japan. 39. Department of Surgery, Tohoku Rosai Hospital, Miyagi, Japan. 40. Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan. 41. Department of Surgery, Nakagami Hospital, Okinawa, Japan. 42. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. 43. Laparoscopic Surgery Center, Tokai Hospital, Aichi, Japan. 44. Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. 45. Department of Surgery, Jichi Medical University, Tochigi, Japan. 46. Chiba Tokushukai Hospital, Chiba, Japan. 47. Oita University, Oita, Japan. 48. Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan. 49. Department of Surgery, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan. 50. Japanese Red Cross Miyagi Blood Center, Miyagi, Japan. 51. Department of Surgery, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kanagawa, Japan. 52. Department of Surgery, Ageo Central General Hospital, Saitama, Japan. 53. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 54. Graduate School of Medicine, Chiba University, Chiba, Japan.
Abstract
BACKGROUND: Generally, surgeons' perceptions of surgical safety are based on experience and institutional policy. Our recent pilot survey demonstrated that the acceptable duration of surgery and criteria for open conversion during laparoscopic cholecystectomy (LC) vary among workplaces. METHODS: A web-based survey was distributed to 554 expert LC surgeons in Japan, Korea, and Taiwan. The questionnaire covered LC experience, safety measures and recognition of landmarks, decision-making regarding conversion to open/partial cholecystectomy and the implications of this decision. Overall responses were compared among nations, and then stratified by LC experience level (lifetime cases 200-499, 500-999, and ≥1,000). RESULTS: The response rate was 92.6% (513/554); 67 surgeons with ≤199 LCs were excluded, and responses from 446 surgeons were analyzed. We observed significant differences among nations on almost all questions. Differences that remained after stratification by LC experience were on questions related to acceptable duration of surgery, adoption rates of intraoperative cholangiography, the "critical view of safety" technique, identification of Rouvière's sulcus, recognition of the SS-Inner layer theory, and intraoperative judgment to abandon conventional LC. CONCLUSIONS: Even among experts, surgeons' perceptions during LC are workplace-dependent. A novel grading system of surgical difficulty and standardized LC procedures are paramount to generate high-level evidence.
BACKGROUND: Generally, surgeons' perceptions of surgical safety are based on experience and institutional policy. Our recent pilot survey demonstrated that the acceptable duration of surgery and criteria for open conversion during laparoscopic cholecystectomy (LC) vary among workplaces. METHODS: A web-based survey was distributed to 554 expert LC surgeons in Japan, Korea, and Taiwan. The questionnaire covered LC experience, safety measures and recognition of landmarks, decision-making regarding conversion to open/partial cholecystectomy and the implications of this decision. Overall responses were compared among nations, and then stratified by LC experience level (lifetime cases 200-499, 500-999, and ≥1,000). RESULTS: The response rate was 92.6% (513/554); 67 surgeons with ≤199 LCs were excluded, and responses from 446 surgeons were analyzed. We observed significant differences among nations on almost all questions. Differences that remained after stratification by LC experience were on questions related to acceptable duration of surgery, adoption rates of intraoperative cholangiography, the "critical view of safety" technique, identification of Rouvière's sulcus, recognition of the SS-Inner layer theory, and intraoperative judgment to abandon conventional LC. CONCLUSIONS: Even among experts, surgeons' perceptions during LC are workplace-dependent. A novel grading system of surgical difficulty and standardized LC procedures are paramount to generate high-level evidence.
Authors: Mariano Eduardo Giménez; Eduardo Javier Houghton; Manuel E Zeledón; Mariano Palermo; Pablo Acquafresca; Caetano Finger; Edgardo Serra Journal: Arq Bras Cir Dig Date: 2018-07-02
Authors: Sarah Z Wennmacker; Nazim Bhimani; Aafke H van Dijk; Thomas J Hugh; Philip R de Reuver Journal: ANZ J Surg Date: 2019-10-22 Impact factor: 1.872