Yukio Iwashita1, Taizo Hibi2, Tetsuji Ohyama3, Goro Honda4, Masahiro Yoshida5, Fumihiko Miura6, Tadahiro Takada6, Ho-Seong Han7, Tsann-Long Hwang8, Satoshi Shinya9, Kenji Suzuki10, Akiko Umezawa11, Yoo-Seok Yoon7, In-Seok Choi12, Wayne Shih-Wei Huang13, Kuo-Hsin Chen14, Manabu Watanabe15, Yuta Abe2, Takeyuki Misawa16, Yuichi Nagakawa17, Dong-Sup Yoon18, Jin-Young Jang19, Hee Chul Yu20, Keun Soo Ahn21, Song Cheol Kim22, In Sang Song23, Ji Hoon Kim24, Sung Su Yun25, Seong Ho Choi26, Yi-Yin Jan8, Yan-Shen Shan27, Chen-Guo Ker28, De-Chuan Chan29, Cheng-Chung Wu30, King-Teh Lee31, Naoyuki Toyota32, Ryota Higuchi33, Yoshiharu Nakamura34, Yoshiaki Mizuguchi35, Yutaka Takeda36, Masahiro Ito37, Shinji Norimizu38, Shigetoshi Yamada39, Naoki Matsumura40, Junichi Shindoh41, Hiroki Sunagawa42, Takeshi Gocho43, Hiroshi Hasegawa44, Toshiki Rikiyama45, Naohiro Sata46, Nobuyasu Kano47, Seigo Kitano48, Hiromi Tokumura40, Yuichi Yamashita49, Goro Watanabe50, Kunitoshi Nakagawa51, Taizo Kimura10, Tatsuo Yamakawa52, Go Wakabayashi53, Rintaro Mori54, Itaru Endo55, Masaru Miyazaki56, Masakazu Yamamoto33. 1. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan. 2. Department of Surgery, Keio University School of Medicine, Tokyo, 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, Fukuoka Kieikai Hospital, Fukuoka, Japan. 10. Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan. 11. Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan. 12. Department of Surgery, Konyang University Hospital, Daejeon, Korea. 13. Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan. 14. Department of Surgery and Department of Electrical Engineering, Far-Eastern Memorial Hospital and Yuan Ze University, New Taipei city Tauyuan, Taiwan. 15. Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan. 16. Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan. 17. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 18. Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea. 19. Department of Surgery, Seoul National University Hospital, Seoul, Korea. 20. Department of Surgery, Chonbuk National University Hospital, Jeonju, Korea. 21. Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. 22. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. 23. Department of Surgery, Chungnam National University Hospital, Daejeon, Korea. 24. Department of Surgery, Eulji University Hospital, Daejeon, Korea. 25. Department of Surgery, Yeungnam University, Daegu, Korea. 26. Department of Surgery, Sungkyunkwan University, Seoul, Korea. 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, Taichung-Veterans General Hospital, Taichung, Taiwan. 31. Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 32. Department of Surgery, Musashino Tokushukai Hospital, Tokyo, Japan. 33. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 34. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. 35. Department of Surgery, Nippon Medical School, Tokyo, Japan. 36. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan. 37. Department of General and Pancreatic Surgery, Quality and Safety in Healthcare, Fujita Health University, Aichi, Japan. 38. Department of Surgery, Nagoya Daini Red Cross Hospital, Aichi, Japan. 39. Department of Surgery, Kameda Medical Center, Chiba, Japan. 40. Department of Surgery, Tohoku Rosai Hospital, Miyagi, Japan. 41. Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan. 42. Department of Gastroenterological Surgery, St. Luke's International Hospital, Tokyo, Japan. 43. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. 44. Laparoscopic Surgery Center, Tokai Hospital, Aichi, Japan. 45. Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. 46. Department of Surgery, Jichi Medical University, Tochigi, Japan. 47. Director, Chiba Tokushukai Hospital, Chiba, Japan. 48. President, Oita University, Oita, Japan. 49. Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan. 50. Department of Surgery, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan. 51. Japanese Red Cross Miyagi Blood Center, Miyagi, Japan. 52. Department of Surgery, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kanagawa, Japan. 53. Department of Surgery, Ageo Central General Hospital, Saitama, Japan. 54. Department of Health Policy and Department of Clinical Epidemiology, National Center for Child Health and Development, Tokyo, Japan. 55. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 56. Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan.
Abstract
BACKGROUND: We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. METHODS: Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median ± 1 after stratification by workplace and LC experience level. RESULTS: Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. 'Diffuse scarring in the Calot's triangle area' in the 'Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. CONCLUSIONS: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.
BACKGROUND: We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. METHODS: Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median ± 1 after stratification by workplace and LC experience level. RESULTS: Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. 'Diffuse scarring in the Calot's triangle area' in the 'Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. CONCLUSIONS: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.
Authors: Marco von Strauss Und Torney; Sohelia Aghlmandi; Jasmin Zeindler; Debora Nowakowski; Christian A Nebiker; Christoph Kettelhack; Rachel Rosenthal; Raoul A Droeser; Savas D Soysal; Henry Hoffmann; Robert Mechera Journal: Surg Endosc Date: 2018-05-21 Impact factor: 4.584
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
Authors: Lucia Ilaria Sgaramella; Angela Gurrado; Alessandro Pasculli; Nicola de Angelis; Riccardo Memeo; Francesco Paolo Prete; Stefano Berti; Graziano Ceccarelli; Marco Rigamonti; Francesco Giuseppe Aldo Badessi; Nicola Solari; Marco Milone; Fausto Catena; Stefano Scabini; Francesco Vittore; Gennaro Perrone; Carlo de Werra; Ferdinando Cafiero; Mario Testini Journal: Surg Endosc Date: 2020-08-11 Impact factor: 4.584