Claudius Conrad1, David Fuks2, Horacio Asbun3, Olivier Soubrane4, Bernard Dallemagne5, Go Wakabayashi6, Jacques Marescaux5, Patrick Pessaux5, Ircad LC Guideline Group5. 1UT MD Anderson Cancer Center, 2Institut Mutualiste Montsouris, 3Mayo Florida, 4Beaujon Hospital, 5IRCAD Strasbourg, 6Ageo Central General Hospital
Introduction: While there is wide diffusion of laparoscopic approach to cholecystectomy (LC), high adverse event rates persists with significant societal implications due to the large number of cholecystectomies performed. An expert guideline conference was conducted to identify factors associated with safe LC with the goal of reducing biliary and/or vascular injury.
Methods and Approach: The IRCAD Guidelines Group was comprised of 19 surgeons from high-volume hepato-pancreato-biliary surgery centers located in 9 countries. A systematic data search of PubMed, Cochrane, and Embase was conducted. Structured group meetings were used to achieve a consensus on method standardization for safe LC. The process identified a list of key items for safer practice of LC. These items were put forward to 99 IRCAD committee members in electronically distributed surveys. Consensus was achieved when at least 80% of respondents ranked an item as 1 or 2 on a Likert scale of importance (1–4).
Results: Guidelines were derived from 26 key items, ranging from exposure of operative field and gallbladder, appropriate use of energy device, establishment of the critical view of safety, systematic preoperative imaging, intraoperative cholangiography and alternative techniques, the role of partial cholecystectomy and dome down (fundus first) cholecystectomy. The highest consensus was achieved on the importance of critical view of safety, dome down technique and partial cholecystectomy being acceptable alternative approaches, A recommendation for a specific type of energy source being used was not brought forward. Preoperative imaging with ultrasound was considered routine while other techniques without special indications were considered not significantly contributory to avoiding adverse events. Other key domains for improvement in training, assessment, and research were identified also.
Conclusions: Despite a low incidence of adverse event during LC overall, the high rate of LC performed leads to a significant number of patients who suffer longterm from adverse events. To reduce this number, guidelines to promote safe surgical practice of LC may help to initiate specific training in the areas including but not limited to single access cholecystectomy. The brought forward guidelines for skill assessment and documentation of critical steps of the operation may contribute to promoting reduction of adverse events.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80051
Program Number: P311
Presentation Session: Poster (Non CME)
Presentation Type: Poster