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Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): a prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed by trainees

  • 2023 EAES Oral
  • Published:
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A Correction to this article was published on 16 January 2024

This article has been updated

Abstract

Aims

The identification of the anatomical components of the Calot’s Triangle during laparoscopic cholecystectomy (LC) might be challenging and its difficulty may increase when a surgical trainee (ST) is in charge, ultimately allegedly affecting also the incidence of common bile duct injuries (CBDIs). There are various methods to help reach the critical view of safety (CVS): intraoperative cholangiogram (IOC), critical view of safety in white light (CVS-WL) and near-infrared fluorescent cholangiography (NIRF-C). The primary objective was to compare the use of these techniques to obtain the CVS during elective LC performed by ST.

Methods

This was a multicentre prospective observational study (Clinicalstrials.gov Registration number: NCT04863482). The impact of three different visualization techniques (IOC, CVS-WL, NIRF-C) on LC was analyzed. Operative time and time to achieve the CVS were considered. All the participating surgeons were also required to fill in three questionnaires at the end of the operation focusing on anatomical identification of the general task and their satisfaction.

Results

Twenty-nine centers participated for a total of 338 patients: 260 CVS-WL, 10 IOC and 68 NIRF-C groups.

The groups did not differ in the baseline characteristics. CVS was considered achieved in all the included case. Rates were statistically higher in the NIR-C group for common hepatic and common bile duct visualization (p = 0.046; p < 0.005, respectively). There were no statistically significant differences in operative time (p = 0.089) nor in the time to achieve the CVS (p = 0.626). Three biliary duct injuries were reported: 2 in the CVS-WL and 1 in the NIR-C. Surgical workload scores were statistically lower in every domain in the NIR-C group. Subjective satisfaction was higher in the NIR-C group. There were no other statistically significant differences.

Conclusions

These data showed that using NIRF-C did not prolong operative time but positively influenced the surgeon's satisfaction of the performance of LC.

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Acknowledgements

The SCOTCH collaborative group is: Gaetano Piccolo M.D, PhD Paolo Pietro Bianchi M.D General Surgery Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, 20142, Italy gpiccolo1983@gmail.com, Silvia Quaresima, P.h.D., Alessandro Maria Paganini, P.h.D., Roma, La Sapienza Policlinico Umberto I Dipartimento Paride Stefanini, s.quaresima@hotmail.com, alessandro.paganini@uniroma1.it. Agresta Ferdinando, U.O. Chirurgia Generale Vittorio Veneto, ferdinandoagresta@gmail.com, Pasquale Lepiane, M.D., UOC of General and Minimally Invasive Surgery, Hospital “San Paolo”, Largo Donatori del Sangue 1, 00053, Civitavecchia, Rome, Italy, pasquale.lepiane@aslroma4.it. Marco Milone, P.h.D., Giovanni De Palma, P.h.D., Chirurgia Endoscopica, Napoli, milone.marco.md@gmail.com, giovannidomenico.depalma@unina.it. Giovanni Emiliani, M.D., Gianluca Baiocchi, P.h.D., Chirurgia Generale, Cremona, giovanni.emiliani3@gmail.com, gianluca.baiocchi@unibs.it. Tommaso Fontana, M.D., Pierenrico Marchesa, P.h.D., ARNAS Civico Di Cristina Benfratelli, tommasofontana2@virgilio.it, Ch.oncologica@arnascivico.it. Aridai Resendiz, M.D., Caterina Puccioni, M.D., San Filippo Neri—Policlinico A. Gemelli, caterinapuccioni@libero.it. Angelo Iossa, P.h.D., Silecchia Gianfranco P.h.D., UOC Chirurgia Generale Atri (TE), angelo.iossa@gmail.com, gianfranco.silecchia@gmail.com. Andrea Picchetto, P.h.D., Giancarlo D’Ambrosio, P.h.D., Policlinico Umberto I, Rome, andreapicchetto@gmail.com, giancarlo.dambrosio@uniroma1.it. Diego Sasia, M.D., Felice Borghi, M.D., Santa Croce and Carle Hospital, Cuneo, diego.sasia@hotmail.it, felice.borghi@unito.it. Cristina Bombardini, M.D., Gabriele Anania, M.D., UO Chirurgia 1, Ferrara, bombardini.cristina@gmail.com, gabriele.anania@unife.it. Michele De Capua, M.D., Giusto Pignata, M.D., Chirurgia generale 2- Spedali civili di Brescia, michele.decapua90@gmail.com, gpignata@libero.it. Alessio Giordano, M.D., Stefano Cantafio, UO Chirurgia Generale, Nuovo Ospedale S. Stefano, Prato, Alessio.giordano8@gmail.com, stefano.cantafio@uslcentro.toscana.it. Francesco Maria Carrano, M.D., Elisa Bigoi, M.D., U.O.C. Chirurgia Generale Busto Arsizio, carranofm@gmail.com, elisa.bigoi@gmail.com. Pasquale Cianci, M.D., Ivana Conversano M.D.,. Ospedale Lorenzo Bonomo Andria (BT) Italia, ciancidoc1@virgilio.it, conversanoivana4@gmail.com. Maria Grazia Sibilla, M.D., Carcoforo Paolo, M.D., Azienda Unità Sanitaria locale di Ferrara, mariagraziasibilla@gmail.com, p.carcoforo@ospfe.it. Francesco Fleres, M.D., Guglielmo Clarizia, UO Chirurgia Generale—ASST Valtellina e Alto Lario, Sondrio Hospital—Sondrio Italy, franz.fleres@gmail.com, guglielmo.clarizia@asst-val.it. Annachiara Casella, M.D., Riccardo Memeo, Chirurgia Epatobiliopancreatica Ospedale Generale Regionale “F.Miulli, annachiara.casella@gmail.com, dott.riccardomemeo@libero.it. Gaetano Gallo, Department of Surgery, Sapienza University, Rome, gaetanogallo1988@gmail.com. Giuseppe Clerico, M.D., Mario Trompetto, P.h.D., U.O. Chirurgia Colorettale—Clinica S. Rita Vercelli, clerico.giuseppe@gmail.com, Trompetto.Mario@libero.it. Fabio Rondelli, M.D., Avenia Nicola, M.D., Christian Ivan Zapana Chillitupa, M.D Chirurgia Generale e Specialità Chirurgiche, fabio.rondelli@unipg.it, unico.avenia@gmail.com, Christianzachi10@gmail.com, Giuseppe Di Buono, M.D., Antonino Agrusa, M.D., UOSD Chirurgia Laparoscopica, giuseppe.dibuono@unipa.it, antonino.agrusa@unipa.it. Diego Cuccurullo, M.D., UOC Chirurgia Generale, Laparoscopica e Robotica, diego.cuccurullo@ospedalideicolli.it. Nicolò Fabbri, M.D., Carlo V. Feo, P.h.D., Azienda Unità Sanitaria Locale di Ferrara, Università di Ferrara, n.fabbri@ausl.fe.it, carlo.feo@unife.it. Nicola Cillara, M.D., Antonello Deserra, M.D., UO di Chirurgia Generale del PO Santissima Trinità ASL Cagliari, ncillara@gmail.com, antonellodeserra@asl8cagliari.it. Nereo Vettoretto, M.D., General Surgery, ASST Spedali Civili di Brescia PO Montichiari, Montichiari—Brescia, Italy, nevett@gmail.com. Sara Liverotti, liverotti.sara@gmail.com. Giorgia Casadei, giorgia.casadei@ospedaliriuniti.marche.it. Federica Marinucci, federica.marinucci@ospedaliriuniti.marche.it

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Authors and Affiliations

  1. Department of General and Emergency Surgery, Università Politecnica delle Marche, Ancona, Italy

    Monica Ortenzi & Mario Guerrieri

  2. Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Rome, Italy

    Diletta Corallino

  3. General Surgery, ASST Spedali Civili di Brescia PO Montichiari, Montichiari, Brescia, Italy

    Emanuele Botteri

  4. Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Andrea Balla

  5. UOC of General and Minimally Invasive Surgery, Hospital “San Paolo”, Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy

    Andrea Balla

  6. Department of Surgical Sciences, University of Torino, Turin, Italy

    Andrea Balla

  7. Department of General Surgery, Ospedale Di Montebelluna, Montebelluna, Treviso, Italy

    Alberto Arezzo

  8. Department of Colorectal Surgery, King’s College Hospital, London, UK

    Alberto Sartori

  9. U.O. Chirurgia Generale, Vittorio Veneto, Italy

    Rossella Reddavid & Giulia Montori

  10. AOU. General Surgery San Luigi Gonzaga, Orbassano, Italy

    Sophie Williams

  11. Department of Surgical Science, University of Cagliari, Cagliari, Italy

    Mauro Podda

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  1. Monica Ortenzi
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the SCOTCH Study Collaborative Group

Contributions

MO conceived the study; MO, MP designed and performed the research; MO, MP, DC analyzed the data; MO, MP, DC, AB, EB, AA, AS, RR, GM wrote the paper; MG supervised the paper; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Monica Ortenzi.

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Monica Ortenzi, Diletta Corallino, Emanuele Botteri, Andrea Balla, Alberto Arezzo, Alberto Sartori, Rossella Reddavid, Giulia Montori, Mario Guerrieri, Sophie Williams, and, Mauro Podda have no conflicts of interest or financial ties to disclose.

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Ortenzi, M., Corallino, D., Botteri, E. et al. Safety of laparoscopic cholecystectomy performed by trainee surgeons with different cholangiographic techniques (SCOTCH): a prospective non-randomized trial on the impact of fluorescent cholangiography during laparoscopic cholecystectomy performed by trainees. Surg Endosc 38, 1045–1058 (2024). https://doi.org/10.1007/s00464-023-10613-w

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