Skip to main content
SpringerLink
Log in

SAGES safe cholecystectomy modules improve practicing surgeons' judgment: results of a randomized, controlled trial

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Despite the advantages of laparoscopic cholecystectomy, major bile duct injury (BDI) rates during this operation remain unacceptably high. In October 2018, SAGES released the Safe Cholecystectomy modules, which define specific strategies to minimize the risk of BDI. This study aims to investigate whether this curriculum can change the knowledge and behaviors of surgeons in practice.

Methods

Practicing surgeons were recruited from the membership of SAGES and the American College of Surgeons Advisory Council for Rural Surgery. All participants completed a baseline assessment (pre-test) that involved interpreting cholangiograms, troubleshooting difficult cases, and managing BDI. Participants' dissection strategies during cholecystectomy were also compared to the strategies of a panel of 15 experts based on accuracy scores using the Think Like a Surgeon validated web-based platform. Participants were then randomized to complete the Safe Cholecystectomy modules (Safe Chole module group) or participate in usually scheduled CME activities (control group). Both groups completed repeat assessments (post-tests) one month after randomization.

Results

Overall, 41 participants were eligible for analysis, including 18 Safe Chole module participants and 23 controls. The two groups had no significant differences in pre-test scores. However, at post-test, Safe Chole module participants made significantly fewer errors managing BDI and interpreting cholangiograms. Safe Chole module participants were less likely to convert to an open operation on the post-test than controls when facing challenging dissections. However, Safe Chole module participants displayed a similar incidence of errors when evaluating adequate critical views of safety.

Conclusions

In this randomized-controlled trial, the SAGES Safe Cholecystectomy modules improved surgeons' abilities to interpret cholangiograms and safely manage BDI. Additionally, surgeons who studied the modules were less likely to convert to open during difficult dissections. These data show the power of the Safe Cholecystectomy modules to affect practicing surgeons' behaviors in a measurable and meaningful way.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. USA Procedure Volumes (2014) Truven analytics, Thompson/Solucient

  2. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW (1992) Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg 127(8):917–921 (discussion 921-3)

    Article  CAS  PubMed  Google Scholar 

  3. NIH Consensus conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269(8):1018–1024

    Article  Google Scholar 

  4. The Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324(16):1073–1078. https://doi.org/10.1056/NEJM199104183241601

    Article  Google Scholar 

  5. Davidoff AM, Pappas TN, Murray EA et al (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215(3):196–202

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Way LW, Stewart L, Gantert W et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237(4):460–469. https://doi.org/10.1097/01.SLA.0000060680.92690.E9

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tornqvist B, Stromberg C, Persson G, Nilsson M (2012) Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 345:e6457. https://doi.org/10.1136/bmj.e6457

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pucher PH, Brunt LM, Davies N et al (2018) Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc 32(5):2175–2183. https://doi.org/10.1007/s00464-017-5974-2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Barrett M, Asbun HJ, Chien HL, Brunt LM, Telem DA (2018) Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc 32(4):1683–1688. https://doi.org/10.1007/s00464-017-5847-8

    Article  PubMed  Google Scholar 

  10. Kern KA (1997) Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences. Arch Surg 132(4):392–397 (discussion 397-8)

    Article  CAS  PubMed  Google Scholar 

  11. Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L (2003) Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 290(16):2168–2173. https://doi.org/10.1001/jama.290.16.2168

    Article  CAS  PubMed  Google Scholar 

  12. Stewart L, Way LW (2009) Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB (Oxford) 11(6):516–522. https://doi.org/10.1111/j.1477-2574.2009.00096.x

    Article  PubMed  Google Scholar 

  13. Lau WY, Lai EC, Lau SH (2010) Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg 80(1–2):75–81. https://doi.org/10.1111/j.1445-2197.2009.05205.x

    Article  PubMed  Google Scholar 

  14. McLean TR (2005) Monetary lessons from litigation involving laparoscopic cholecystectomy. Am Surg 71(7):606–612

    Article  PubMed  Google Scholar 

  15. Hariharan D, Psaltis E, Scholefield JH, Lobo DN (2017) Quality of life and medico-legal implications following iatrogenic bile duct injuries. World J Surg 41(1):90–99. https://doi.org/10.1007/s00268-016-3677-9

    Article  PubMed  Google Scholar 

  16. The SAGES Safe Cholecystectomy Program. https://wwwsages.org/safe-cholecystectomy-program/. Accessed 1 Oct 2018

  17. Pucher PH, Brunt LM, Fanelli RD, Asbun HJ, Aggarwal R (2015) SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 29(11):3074–3085. https://doi.org/10.1007/s00464-015-4079-z

    Article  PubMed  Google Scholar 

  18. Booij KA, de Reuver PR, Nijsse B, Busch OR, van Gulik TM, Gouma DJ (2014) Insufficient safety measures reported in operation notes of complicated laparoscopic cholecystectomies. Surgery 155(3):384–389. https://doi.org/10.1016/j.surg.2013.10.010

    Article  PubMed  Google Scholar 

  19. Daly SC, Deziel DJ, Li X et al (2016) Current practices in biliary surgery: do we practice what we teach? Surg Endosc 30(8):3345–3350. https://doi.org/10.1007/s00464-015-4609-8

    Article  PubMed  Google Scholar 

  20. Deal SB, Stefanidis D, Telem D et al (2017) Evaluation of crowd-sourced assessment of the critical view of safety in laparoscopic cholecystectomy. Surg Endosc 31(12):5094–5100. https://doi.org/10.1007/s00464-017-5574-1

    Article  PubMed  Google Scholar 

  21. Nijssen MA, Schreinemakers JM, van der Schelling GP, Crolla RM, Rijken AM (2016) Improving critical view of safety in laparoscopic cholecystectomy by teaching interventions. J Surg Educ 73(3):442–447. https://doi.org/10.1016/j.jsurg.2015.11.015

    Article  PubMed  Google Scholar 

  22. Stefanidis D, Chintalapudi N, Anderson-Montoya B, Oommen B, Tobben D, Pimentel M (2017) How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc 31(1):142–146. https://doi.org/10.1007/s00464-016-4943-5

    Article  PubMed  Google Scholar 

  23. Nijssen MA, Schreinemakers JM, Meyer Z, van der Schelling GP, Crolla RM, Rijken AM (2015) Complications after laparoscopic cholecystectomy: a video evaluation study of whether the critical view of safety was reached. World J Surg 39(7):1798–1803. https://doi.org/10.1007/s00268-015-2993-9

    Article  CAS  PubMed  Google Scholar 

  24. Madani A, Watanabe Y, Bilgic E et al (2017) Measuring intra-operative decision-making during laparoscopic cholecystectomy: validity evidence for a novel interactive Web-based assessment tool. Surg Endosc 31(3):1203–1212. https://doi.org/10.1007/s00464-016-5091-7

    Article  PubMed  Google Scholar 

  25. Brunt LM, Deziel DJ, Telem DA et al (2020) Safe Cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 272(1):3–23. https://doi.org/10.1097/SLA.0000000000003791

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by a SAGES research grant.

Author information

Authors and Affiliations

  1. University of Texas Health Science Center at Houston, Houston, USA

    Joshua Weis

  2. Washington University in St. Louis, St. Louis, USA

    L. Michael Brunt

  3. University Health Network, Toronto, ON, Canada

    Amin Madani

  4. University of Michigan, Ann Arbor, USA

    Dana Telem

  5. University of Texas Southwestern Medical Center at Dallas, Dallas, USA

    Madhuri Nagaraj

  6. Miami Cancer Institute, Miami, FL, USA

    Horacio Asbun

  7. Texas Tech Paul L. Foster School of Medicine, El Paso, TX, USA

    Brian R. Davis

  8. Texas Tech University Health Science Center, Lubbock, TX, USA

    Sharmila Dissanaike

  9. NorthShore University Health System, Evanston, USA

    Michael B. Ujiki

  10. Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, USA

    Carl J. Westcott

  11. University of California San Francisco, San Francisco, USA

    Adnan Alseidi

Authors
  1. Joshua Weis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Michael Brunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amin Madani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dana Telem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Madhuri Nagaraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Horacio Asbun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Brian R. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sharmila Dissanaike
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael B. Ujiki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carl J. Westcott
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Adnan Alseidi
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

SAGES Safe Chole Task Force

  • Rajesh Aggarwal
  • , Robert Bailey
  • , Allison Barrett
  • , George Berci
  • , Ali Butash
  • , Daniel Deziel
  • , Abe Fingerhut
  • , Denise Gee
  • , Sujata Gill
  • , Angela Hanna
  • , Sara Holden
  • , Dhiresh Jeyarajah
  • , Tommy Lee
  • , Marian Mcdonald
  • , Marc Mesleh
  • , Eduardo Moreno-Paquentin
  • , Mauricio Pasten Vargas
  • , Michael Pucci
  • , Philip Pucher
  • , Byron Santos
  • , Ranbir Singh
  • , Dimitrios Stefanidis
  • , Nathaniel Stoikes
  • , Levan Tsamalaidze
  • , Richard Vazquez
  • , Go Wakabayashi
  • , Kevin Wasco
  •  & Mark Watson

Corresponding author

Correspondence to Joshua Weis.

Ethics declarations

Disclosure

Dr. Joshua Weis reports grants from SAGES, during the conduct of the study. Dr. L. Michael Brunt established the Safe Cholecystectomy initiative while serving as SAGES president. He served as chair of the Safe Chole Task Force during the conduct of the study. Dr. Amin Madani has nothing to disclose. Dr. Dana Telem reports personal fees from Covidien, outside the submitted work. She also serves as the current chair of the Safe Chole Task Force. Dr. Madhuri Nagaraj has nothing to disclose. Dr. Horacio Asbun has nothing to disclose. Dr. Brian Davis has nothing to disclose. Dr. Michael Ujiki reports personal fees from Boston Scientifc and Covidien, outside the submitted work. Dr. Adnan Alseidi reports grants from SAGES, during the conduct of the study. He also reports personal fees from Medical Device Business Services and Ethicon, outside the submitted work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weis, J., Brunt, L.M., Madani, A. et al. SAGES safe cholecystectomy modules improve practicing surgeons' judgment: results of a randomized, controlled trial. Surg Endosc 37, 862–870 (2023). https://doi.org/10.1007/s00464-022-09503-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09503-4

Keywords

Search

Navigation