Benjamin Carr, MD, Niki Matusko, BS, Gurjit Sandhu, PhD, Oliver Varban, MD. University of Michigan
INTRODUCTION: Recent studies suggest that the critical view of safety (CVS) as originally defined by Strasberg and colleagues may be achieved in fewer than 20% of laparoscopic cholecystectomy (LC) cases. This implies high variability in surgeons’ understanding of the CVS, or in their visual perceptions of the CVS dissection. We sought to define the level of consensus on adequacy of the CVS dissection among faculty and residents at our institution.
METHODS: Participating residents and faculty viewed a series of twenty surgical videos, lasting one minute each, showing the laparoscopic view at various points in the CVS dissection during LC. For each video, surgeons were asked to state whether they felt the structures were safe to clip and cut at that point, and if not, what further operative steps they would take to achieve an adequate dissection.
Cohen’s kappa statistic was used to evaluate inter-rater reliability. Consensus among all raters, consensus between faculty and residents, and consensus among and between different specialties and levels of training were assessed. Agreement between video reviewers and the actual operative decision were also compared.
RESULTS: Thirteen of 36 faculty (36.1%) and 13 of 43 residents (30.2%) participated. Among all raters, there was minimal agreement on the safety of dissection (κ=.25). There was minimal agreement among faculty (κ=.30), and minimal agreement among residents (κ=.21). There was no more than weak agreement within subspecialties (κ= -.18 – .47) or between subspecialties (κ=.29 – .40). No faculty and no residents had more than moderate agreement with the actual operative decision (κ= -.20 – .60). There was no agreement among any raters on what further operative steps should be taken, even for videos where all raters agreed the CVS had not been achieved.
CONCLUSION: Though most surgeons would agree the CVS is essential for safe LC, there is a high degree of variability in surgeons’ perceptions of the critical view of safety, within and across specialties and levels of training. Further educational efforts are required to achieve consensus on what constitutes an adequate dissection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79581
Program Number: S008
Presentation Session: Biliary
Presentation Type: Podium
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