Application of a novel surgical difficulty grading system during laparoscopic cholecystectomy

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 29; no. 7; pp. 758 - 767
• Main Authors: Asai, Koji, Iwashita, Yukio, Ohyama, Tetsuji, Endo, Itaru, Hibi, Taizo, Umezawa, Akiko, Suzuki, Kenji, Watanabe, Manabu, Kurata, Masanao, Mori, Yasuhisa, Higashida, Masaharu, Kumamoto, Yusuke, Shindoh, Junichi, Yoshida, Masahiro, Honda, Goro, Misawa, Takeyuki, Abe, Yuta, Nagakawa, Yuichi, Toyota, Naoyuki, Yamada, Shigetoshi, Norimizu, Shinji, Matsumura, Naoki, Sata, Naohiro, Sunagawa, Hiroki, Ito, Masahiro, Takeda, Yutaka, Nakamura, Yoshiharu, Rikiyama, Toshiki, Higuchi, Ryota, Gocho, Takeshi, Homma, Yuki, Hirashita, Teijiro, Kanemoto, Hideyuki, Nozawa, Masashi, Watanabe, Yusuke, Kohga, Atsushi, Yazawa, Takehisa, Tajima, Hiroshi, Nakahira, Shin, Asaoka, Tadafumi, Yoshioka, Ryuji, Fukuzawa, Junya, Fujioka, Shuichi, Hata, Taigo, Haruta, Hidenori, Asano, Yukio, Nomura, Ryohei, Matsumoto, Joe, Kameyama, Noriaki, Miyoshi, Atsushi, Urakami, Hidejiro, Seyama, Yasuji, Morikawa, Takanori, Kawano, Yoichi, Ikoma, Hisashi, Kin, Dal Ho Kim, Takada, Tadahiro, Yamamoto, Masakazu
• Format: Journal Article
• Language: English
• Published: Tokyo Wiley Subscription Services, Inc 01-07-2022
• Subjects: acute cholecystitis; bile duct injury; Cholecystectomy; Gallbladder diseases; laparoscopic cholecystectomy; Laparoscopy; surgical difficulty; vasculobiliary injury
• DOI: 10.1002/jhbp.1068
• EISSN: 1868-6982
• ISSN: 1868-6974

Background
Prevention of bile duct injury and vasculo‐biliary injury while performing laparoscopic cholecystectomy (LC) is an unsolved problem. Clarifying the surgical difficulty using intraoperative findings can greatly contribute to the pursuit of best practices for acute cholecystitis. In this study, multiple evaluators assessed surgical difficulty items in unedited videos and then constructed a proposed surgical difficulty grading.
Methods
We previously assembled a library of typical video clips of the intraoperative findings for all LC surgical difficulty items in acute cholecystitis. Fifty‐one experts on LC assessed unedited surgical videos. Inter‐rater agreement was assessed by Fleiss's κ and Gwet's agreement coefficient (AC).
Results
Except for one item (“edematous change”), κ or AC exceeded 0.5, so the typical videos were judged to be applicable. The conceivable surgical difficulty gradings were analyzed. According to the assessment of difficulty factors, we created a surgical difficulty grading system (agreement probability = 0.923, κ = 0.712, 90% CI: 0.587‐0.837; AC2 = 0.870, 90% CI: 0.768‐0.972).
Conclusion
The previously published video clip library and our novel surgical difficulty grading system should serve as a universal objective tool to assess surgical difficulty in LC.
Asai et al. established a novel surgical difficulty grading system for laparoscopic cholecystectomy based on 25 items adopted by international consensus among over 500 surgeons. This grading system, together with the previously published video clip library, should serve as a universal objective tool to assess surgical difficulty in laparoscopic cholecystectomy.