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Increasing resident utilization and recognition of the critical view of safety during laparoscopic cholecystectomy: a pilot study from an academic medical center

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Abstract

Background

Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure; however, it is associated with an increased rate of bile duct injury (BDI) when compared to the open approach. The critical view of safety (CVS) provides a secure method of ductal identification to help avoid BDI. CVS is not universally utilized by practicing surgeons and/or taught to surgical residents. We aimed to pilot a safe cholecystectomy curriculum to demonstrate that educational interventions could improve resident adherence to and recognition of the CVS during LC.

Methods

Forty-three general surgery residents at Thomas Jefferson University Hospital were prospectively studied. Fifty-one consecutive LC cases were recorded during the pre-intervention period, while the residents were blinded to the outcome measured (CVS score). As an intervention, a comprehensive lecture on safe cholecystectomy was given to all residents. Fifty consecutive LC cases were recorded post-intervention, while the residents were empowered to “time-out” and document the CVS with a doublet photograph. Two independent surgeons scored the videos and photographs using a 6-point scale. Residents were surveyed pre- and post-intervention to determine objective knowledge and self-reported comfort using a 5-point Likert scale.

Results

In the 18-week study period, 101 consecutive LCs were adequately captured and included (51 pre-intervention, 50 post-intervention). Patient demographics and clinical data were similar. The mean CVS score improved from 2.3 to 4.3 (p < 0.001). The number of videos with CVS score >4 increased from 15.7 to 52 % (p < 0.001). There was strong inter-observer agreement between reviewers. The pre- and post-intervention questionnaire response rates were 90.7 and 83.7 %, respectively. A greater number of residents correctly identified all criteria of the CVS post-intervention (41–93 %, p < 0.001) and offered appropriate bailout techniques (77–94 %, p < 0.001). Residents strongly agreed that the CVS education should be included in general surgery residency curriculum (mean Likert score = 4.71, SD = 0.54). Residents also agreed that they are more comfortable with their LC skills after the intervention (4.27, σ = 0.83).

Conclusion

The combination of focused education along with intraoperative time-out significantly improved CVS scores and knowledge during LC in our institution.

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Acknowledgments

The authors would like to thank Christian de Laszlo for his support and assistance in the technical acquisition of data for this study. Additionally, we would like to thank the nursing staff at the Thomas Jefferson University Hospitals for their continued assistance in the excellent and safe care of our patients.

Funding

Funding was received from Department of Surgery Pilot Research Grant, Thomas Jefferson University.

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Authors and Affiliations

  1. Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Crystal B. Chen, Francesco Palazzo, Stephen M. Doane, Jordan M. Winter, Harish Lavu, Karen A. Chojnacki, Ernest L. Rosato, Charles J. Yeo & Michael J. Pucci

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  1. Crystal B. Chen
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  2. Francesco Palazzo
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  3. Stephen M. Doane
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  7. Ernest L. Rosato
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Corresponding author

Correspondence to Michael J. Pucci.

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Disclosures

The authors, specifically Ms. Chen, Doctors Doane, Palazzo, Winter, Lavu, Chojnacki, Rosato, Yeo, and Pucci, have no conflicts of interest or financial ties to disclose.

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Chen, C.B., Palazzo, F., Doane, S.M. et al. Increasing resident utilization and recognition of the critical view of safety during laparoscopic cholecystectomy: a pilot study from an academic medical center. Surg Endosc 31, 1627–1635 (2017). https://doi.org/10.1007/s00464-016-5150-0

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