TY - JOUR
T1 - Development of a novel intraoperative difficulty score for minimally invasive cholecystectomy
AU - Calkins, Brittany
AU - Chininis, Jeff
AU - Williams, Gregory A.
AU - Sanford, Dominic E.
AU - Hammill, Chet W.
N1 - Publisher Copyright:
© 2020
PY - 2021/7
Y1 - 2021/7
N2 - Background: The rate of biliary injuries from minimally invasive cholecystectomy has remained high for over two decades. To improve outcomes there are multiple bail-out methods described, including aborting the procedure, converting to open, or performing a sub-total cholecystectomy. However, the intraoperative difficulty threshold for when a bail-out method should be implemented is poorly understood. Methods: From 1/2014 to 2/2019 cholecystectomy videos were collected, de-identified, edited to include the 2–3 minutes when the gallbladder was first visualized, and accelerated. They were then rated on a 5-point difficulty scale. Inter-coder reliability was evaluated using Krippendorff's alpha and regression models were used to evaluate the scores ability to predict the need for a bail-out technique. Results: 62 videos were analyzed with a median length after editing of 37.5 (29.0–43.3) seconds. A median time of 46.2 (38.3–53.4) seconds was required for grading. The bail-out rate was 42.9%. The inter-coder reliability between 2 surgeons and 8 non-clinical reviewers was 0.675 with an average difficulty score of 3.0 (SD = 1.01). Regression models showed that the scale was able to significantly predict conversion (β=0.56,p<.01). Conclusion: This novel difficulty score was able to predict conversion to a bail-out technique early in the course of minimally invasive cholecystectomy.
AB - Background: The rate of biliary injuries from minimally invasive cholecystectomy has remained high for over two decades. To improve outcomes there are multiple bail-out methods described, including aborting the procedure, converting to open, or performing a sub-total cholecystectomy. However, the intraoperative difficulty threshold for when a bail-out method should be implemented is poorly understood. Methods: From 1/2014 to 2/2019 cholecystectomy videos were collected, de-identified, edited to include the 2–3 minutes when the gallbladder was first visualized, and accelerated. They were then rated on a 5-point difficulty scale. Inter-coder reliability was evaluated using Krippendorff's alpha and regression models were used to evaluate the scores ability to predict the need for a bail-out technique. Results: 62 videos were analyzed with a median length after editing of 37.5 (29.0–43.3) seconds. A median time of 46.2 (38.3–53.4) seconds was required for grading. The bail-out rate was 42.9%. The inter-coder reliability between 2 surgeons and 8 non-clinical reviewers was 0.675 with an average difficulty score of 3.0 (SD = 1.01). Regression models showed that the scale was able to significantly predict conversion (β=0.56,p<.01). Conclusion: This novel difficulty score was able to predict conversion to a bail-out technique early in the course of minimally invasive cholecystectomy.
UR - http://www.scopus.com/inward/record.url?scp=85096375900&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2020.10.020
DO - 10.1016/j.hpb.2020.10.020
M3 - Article
C2 - 33218950
AN - SCOPUS:85096375900
SN - 1365-182X
VL - 23
SP - 1025
EP - 1029
JO - HPB
JF - HPB
IS - 7
ER -