Pietro Mascagni1,2, Claudio Fiorillo3, Takeshi Urade4, Taha Emre5, Tong Yu5, Taiga Wakabayashi6, Emanuele Felli7, Silvana Perretta4,6,7, Lee Swanstrom4, Didier Mutter4,6,7, Jacques Marescaux4,6, Patrick Pessaux4,6,7, Guido Costamagna3,4, Nicolas Padoy5, Bernard Dallemagne4,6. 1. ICube, University of Strasbourg, CNRS, IHU Strasbourg, Strasbourg, France. p.mascagni@hotmail.it. 2. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. p.mascagni@hotmail.it. 3. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 4. IHU Strasbourg - Institut de Chirurgie Guidée par l'image, Strasbourg, France. 5. ICube, University of Strasbourg, CNRS, IHU Strasbourg, Strasbourg, France. 6. IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France. 7. Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France.
Abstract
BACKGROUND: In laparoscopic cholecystectomy (LC), achievement of the Critical View of Safety (CVS) is commonly advocated to prevent bile duct injuries (BDI). However, BDI rates remain stable, probably due to inconsistent application or a poor understanding of CVS as well as unreliable reporting. Objective video reporting could serve for quality auditing and help generate consistent datasets for deep learning models aimed at intraoperative assistance. In this study, we develop and test a method to report CVS using videos. METHOD: LC videos performed at our institution were retrieved and the video segments starting 60 s prior to the division of cystic structures were edited. Two independent reviewers assessed CVS using an adaptation of the doublet view 6-point scale and a novel binary method in which each criterion is considered either achieved or not. Feasibility to assess CVS in the edited video clips and inter-rater agreements were evaluated. RESULTS: CVS was attempted in 78 out of the 100 LC videos retrieved. CVS was assessable in 100% of the 60-s video clips. After mediation, CVS was achieved in 32/78(41.03%). Kappa scores of inter-rater agreements using the doublet view versus the binary assessment were as follows: 0.54 versus 0.75 for CVS achievement, 0.45 versus 0.62 for the dissection of the hepatocystic triangle, 0.36 versus 0.77 for the exposure of the lower part of the cystic plate, and 0.48 versus 0.79 for the 2 structures connected to the gallbladder. CONCLUSIONS: The present study is the first to formalize a reproducible method for objective video reporting of CVS in LC. Minute-long video clips provide information on CVS and binary assessment yields a higher inter-rater agreement than previously used methods. These results offer an easy-to-implement strategy for objective video reporting of CVS, which could be used for quality auditing, scientific communication, and development of deep learning models for intraoperative guidance.
BACKGROUND: In laparoscopic cholecystectomy (LC), achievement of the Critical View of Safety (CVS) is commonly advocated to prevent bile duct injuries (BDI). However, BDI rates remain stable, probably due to inconsistent application or a poor understanding of CVS as well as unreliable reporting. Objective video reporting could serve for quality auditing and help generate consistent datasets for deep learning models aimed at intraoperative assistance. In this study, we develop and test a method to report CVS using videos. METHOD: LC videos performed at our institution were retrieved and the video segments starting 60 s prior to the division of cystic structures were edited. Two independent reviewers assessed CVS using an adaptation of the doublet view 6-point scale and a novel binary method in which each criterion is considered either achieved or not. Feasibility to assess CVS in the edited video clips and inter-rater agreements were evaluated. RESULTS: CVS was attempted in 78 out of the 100 LC videos retrieved. CVS was assessable in 100% of the 60-s video clips. After mediation, CVS was achieved in 32/78(41.03%). Kappa scores of inter-rater agreements using the doublet view versus the binary assessment were as follows: 0.54 versus 0.75 for CVS achievement, 0.45 versus 0.62 for the dissection of the hepatocystic triangle, 0.36 versus 0.77 for the exposure of the lower part of the cystic plate, and 0.48 versus 0.79 for the 2 structures connected to the gallbladder. CONCLUSIONS: The present study is the first to formalize a reproducible method for objective video reporting of CVS in LC. Minute-long video clips provide information on CVS and binary assessment yields a higher inter-rater agreement than previously used methods. These results offer an easy-to-implement strategy for objective video reporting of CVS, which could be used for quality auditing, scientific communication, and development of deep learning models for intraoperative guidance.
Entities:
Keywords:
Bile duct injury; Critical View of Safety; Laparoscopic cholecystectomy; Objective video reporting; Surgical data science; Surgical safety
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