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How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy?

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Abstract

Background

The reported incidence (0.16–1.5 %) of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is higher than during open cholecystectomy and has not decreased over time despite increasing experience with the procedure. The “critical view of safety” (CVS) technique may help to prevent BDI when certain criteria are met prior to division of any structures. This study aimed to evaluate the adherence of practicing surgeons to the CVS criteria during LC and the impact of a training intervention on CVS identification.

Methods

LC procedures of general surgeons were video-recorded. De-identified recordings were reviewed by a blinded observer and rated on a 6-point scale using the previously published CVS criteria. A coaching program was conducted, and participating surgeons were re-assessed in the same manner.

Results

The observer assessed ten LC videos, each involving a different surgeon. The CVS was adequately achieved by two surgeons (20 %). The remaining eight surgeons (80 %) did not obtain adequate CVS prior to division of any structures, despite two surgeons dictating that they did; the mean score of this group was 1.75. After training, five participating surgeons (50 %) scored > 4, and the mean increased from 1.75 (baseline) to 3.75 (p < 0.05).

Conclusions

The CVS criteria were not routinely used by the majority of participating surgeons. Further, one-fourth of those who claimed to obtain the CVS did so inadequately. All surgeons who participated in training showed improvement during their post-assessment. Our findings suggest that education of practicing surgeons in the application of the CVS during LC can result in increased implementation and quality of the CVS. Pending studies with larger samples, our findings may partly explain the sustained BDI incidence despite increased experience with LC. Our study also supports the value of direct observation of surgical practices and subsequent training for quality improvement.

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Acknowledgments

Financial support for this study was provided through a Leading Edge Advanced Practice Topics (LEAPT) grant by the Center for Medicare and Medicaid Services.

Authors’ contributions

Stefanidis was involved in study conception and design; Chintalapudi, Tobben, and Pimentel acquired the data; Anderson-Montoya, Oommen, and Stefanidis analyzed and interpreted the data; Chintalapudi, Oommen, and Stefanidis drafted the manuscript; Anderson-Montoya and Stefanidis critically revised the manuscript.

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Authors and Affiliations

  1. Division of Bariatric Surgery, Department of Surgery, Carolinas HealthCare System, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC, 28204, USA

    Dimitrios Stefanidis & Bindhu Oommen

  2. Division of Quality, Carolinas HealthCare System, Charlotte, NC, USA

    Nikita Chintalapudi & Brittany Anderson-Montoya

  3. Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, USA

    Dimitrios Stefanidis, Daniel Tobben & Manuel Pimentel

  4. University of North Carolina, Chapel Hill, NC, USA

    Dimitrios Stefanidis

Authors
  1. Dimitrios Stefanidis
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  2. Nikita Chintalapudi
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  3. Brittany Anderson-Montoya
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  4. Bindhu Oommen
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  5. Daniel Tobben
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  6. Manuel Pimentel
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Corresponding author

Correspondence to Dimitrios Stefanidis.

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Disclosures

Dimitrios Stefanidis has received honoraria by WL Gore and Davol for teaching and research support by Ethicon Inc. that are unrelated to this project. Bindhu Oommen, Nikita Chintalapudi, Brittany Anderson-Montoya, Daniel Tobben, and Manuel Pimentel have no conflict of interest or financial ties to disclose.

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Stefanidis, D., Chintalapudi, N., Anderson-Montoya, B. et al. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy?. Surg Endosc 31, 142–146 (2017). https://doi.org/10.1007/s00464-016-4943-5

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  • DOI: https://doi.org/10.1007/s00464-016-4943-5

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