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 - Funding Information:
This research was supported by the 2019 Summer Research Program of the Institute for Public Health- Public and Global Health Track at Washington University in St. Louis funded by the Global Health Center at the Institute for Public Health , Children’s Discovery Institute of Washington University and St. Louis Children's Hospital .
Funding Information:
This research was supported by the 2019 Summer Research Program of the Institute for Public Health- Public and Global Health Track at Washington University in St. Louis funded by the Global Health Center at the Institute for Public Health, Children's Discovery Institute of Washington University and St. Louis Children's Hospital.
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 -