Critical factors for safe surgical practice for laparoscopic cholecystectomy: A SAGES expert Delphi consensus

Philip H Pucher, MD, MRCS1, L Michael Brunt, MD, FACS2, Robert D Fanelli, MD, MHA, FACS, FASGE3, Horacio J Asbun, MD, FACS4, Rajesh Aggarwal, MBBS, MA, PhD, FRCS5. 1Imperial College London, 2Washington University School of Medicine, 3The Guthrie Clinic, Sayre, PA, 4Mayo Clinic Florida, Jacksonville, FL, 5McGill University

Background: Although it has been 25 years since the introduction of laparoscopy to cholecystectomy, outcomes remain largely unchanged, with rates of bile duct injury higher in the modern age than in the era of open surgery. The SAGES Safe Cholecystectomy Task Force (SCTF) initiative seeks to encourage a culture of safety in laparoscopic cholecystectomy (LC) and reduce biliary injury. An expert consensus study was conducted to identify interventions thought to be most effective in pursuit of this goal.

Methods: An initial list of items for safer practice in LC were identified by the SCTF through a Nominal Group Technique (NGT) process. These were put forward to 407 SAGES committee members in two-stage electronically distributed Delphi surveys. Consensus was achieved if at least 80% of respondents ranked an item as 4 or 5 on a Likert scale of importance (1-5). Additionally, respondents ranked five top areas of importance for the following domains: training, assessment, and research.

Results: 39 initial items were identified through NGT. Response rates for each Delphi round were 40.2% and 34%, respectively. Final consensus was achieved on 15 items, the majority of which related to non-technical factors in LC. Key domains for training, assessment, and research were identified. Critical view of safety was deemed most important for overall safety, as well as training and assessment of LC. Intraoperative cholangiography was identified as an additional priority area for future research.

Conclusions: Consensus items to progress surgical practice, training, assessment, and research have been identified, to promote safe practice and improve patient outcomes in LC.

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