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Live QA, live image sharing and grading to evaluate the CVS in cholecystitis

Kathryn S Sobba, MD, Adolfo Fernandez, MD, Stephen Mcnatt, MD, Myron Powell, MD, Andrew Nunn, MD, Amy Hildreth, MD, Clancy Clark, MD, Barbara Yoza, PhD, Lauren Mccormack, MD, Amit Saha, PhD, Jessica Gross, MD, Preston Miller, MD, Carl Westcott, MD, Matthew Tufts, MD. Wake Forest Baptist Medical Center

OBJECTIVE: The Critical View of safety is a technique widely believed to decrease the risk of bile duct injury. The general quality of CVS in cholecystectomy has been studied and those evaluations generally questioned the consistency and accuracy of the CVS in practice. The aim of this study is to use an already established SMS image sharing and grading system to evaluate if and how cholecystitis changes surgeons ability to attain a CVS. 

METHODS AND PROCEDURES: Live QA is an image sharing and grading system where a standard doublet CVS image set can be sent by sms picture/text via hand held smart phones to a group of experts. No PHI is put at risk. A grade for the two images is immediately provided and returned to the operating team. 38 urgent laparoscopic cholecystectomies done for cholecystitis and 117 done for gallstones by sixteen surgeons between 8/2017 and 9/2018 were included. CVS doublets were attained prior to clipping and sent out to the group. The images were graded remotely and returned. The ability to attain good grades and the consistency of scores amongst the graders were compared between the two groups.  

RESULTS: There were no bile duct injuries or leaks. There was 1 post operative hematoma in the inflamed group that required operative evacuation. The average time to first response was less than 2 minutes and the average number of responses was 3.6. Average CVS scores were lower for cholecystitis patients (anterior average 5.41 vs 5.45 in cholecystitis (p value 0.836), posterior average 5.16 vs 4.95 in cholecystitis (p value 0.375)), however a sufficient CVS grade (5 or better in at least one view) was attained in 36 of 38. The consistency of CVS scores for cholecystitis patients was 91% for anterior images and 86% for posterior images (p value 0.69).

CONCLUSIONS: Adequate CVS is almost always attainable in cholecystitis, however pericystic inflammation decreases CVS quality and grading agreement. The posterior view suffers and varies the most. Larger sample sizes would be needed to study the CVS and the effect of this image grading system on adverse events associated with cholecystectomy.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94764

Program Number: P248

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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