Mohammed H Al Mahroos, MD, FRCSC, Mohsen AlHashemi, MD, Amin Madani, MD, PhD, Julio F Fiore Junior, PhD, Melina Vassiliou, MD, MED, FRCSC, FACS, Gerald M Fried, MD, FCRCSC, FACS, Liane S Feldman, MD, FRCSC, FACS. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC
Introduction: Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy. SAGES Safety in Cholecystectomy Task Force recommends obtaining “critical view of safety” (CVS) prior to division of ductal structures. CVS includes 3 components: clearing Calot’s triangle from fat and fibrous tissue, separating the lower part of the gallbladder from the liver bed and confirming only 2 structures entering the gallbladder. However, awareness and use of CVS in the community is not known.The purpose of this pilot study was to develop a platform to evaluate knowledge and estimate the degree to which practicing surgeons identify CVS.
Method: We edited 7 laparoscopic cholecystectomy videos demonstrating different parts of dissection and a final view showing either a completed (3 cases) or incompleted CVS (4 cases). Videos were embedded in a survey that included items about the definition of CVS, whether CVS was achieved and whether surgeons would clip ductal structures without further dissection. Surgeons were asked to choose components of CVS from a list of 11 options that included the 3 correct and 8 incorrect components. The survey was sent to attending surgeons performing cholecystectomy in a university hospital network. Survey-link: (https://www.surveymonkey.com/r/BPFWDY6)
Results: The survey was sent to 34 surgeons and 16 responded; 6 (38%) with >15 years of experience. When asked to select components of CVS, 8 (50%) chose only the correct components, 5 (31%) added extra components, and 3 (19%) missed at least one. In the 3 videos where CVS was demonstrated, 75 to 82% (mean77%) correctly agreed CVS was obtained. The remaining felt more separation from the liver bed was required before clipping. In the 4 videos where CVS was not demonstrated, 50 to 87% (mean72%) agreed CVS was not obtained. In 14% of instances the surgeon felt comfortable dividing ductal structures despite correctly recognizing that CVS was not obtained. In these instances, surgeons felt it was safe to clip prior to full dissection of the lower part of gallbladder from the liver bed.
Conclusion: In this platform, only half of surgeons precisely identified the components of CVS but were still able to correctly identify when CVS was obtained in most cases. There was less agreement in cases where CVS was not obtained, largely due to judgment about the adequacy of dissection of the lower part of the gallbladder from the liver. This suggests areas to target for educational interventions to promote safety if confirmed in a larger study.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80493
Program Number: P098
Presentation Session: Poster (Non CME)
Presentation Type: Poster