Advertisement

Lacunar implementation of the critical view of safety technique for laparoscopic cholecystectomy: Results of a nationwide survey

Published:March 07, 2018DOI:https://doi.org/10.1016/j.surg.2018.01.016

      Abstract

      Background

      Bile duct injury remains a dilemma in laparoscopic cholecystectomy, with an incidence still higher than in conventional cholecystectomy. The Critical View of Safety technique is used as one of the important operating technique to reduce bile duct injury incidence. The objective of this study was to determine current practices in laparoscopic cholecystectomy and the use of the Critical View of Safety technique among surgeons and residents in surgical training.

      Methods

      We conducted an electronic survey among all affiliated members of the Association of Surgeons of the Netherlands containing questions regarding the current practice of laparoscopic cholecystectomy, essential steps of the Critical View of Safety technique, reasons for conversion to open cholecystectomy, and the use of other safety techniques.

      Results

      The response rate was 37% (766/2,055). In the study, 610 completed surveys were analyzed. Of the respondents, 410 (67.2%) were surgeons and 200 (32.8%) were residents in surgical training. Furthermore, 98.2% of the respondents indicated incorporating the Critical View of Safety technique into current practice. However, only 72% of respondents performed the essential steps of the Critical View of Safety technique frequently. Subsequently, half of respondents were able to identify the corresponding steps of the Critical View of Safety technique, and only 16.9% were able to distinguish these adequately from possible harmful steps. Furthermore, 74.9% selected ≥1 possible harmful steps as part of this technique. Residents significantly performed and selected the essential steps of the Critical View of Safety technique more often than surgeons. Intraoperative cholangiography, intraoperative ultrasound, and fluorescence cholangiography are seldom used. Bail-out techniques such as subtotal cholecystectomy, fundus first dissection, and leaving the gallbladder in situ are familiar to the majority of respondents.

      Conclusion

      Responses indicate that practically all Dutch surgeons and residents claim to use the Critical View of Safety technique. The majority of surgeons and residents are unable to discern correctly the essential steps of the Critical View of Safety technique from actions not part of the technique and even potentially harmful. Residents' current knowledge regarding the Critical View of Safety technique is superior to those of surgeons.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Reynolds W.
        The first laparoscopic cholecystectomy.
        JSLS. 2001; 5: 89-94
        • Eurostat
        Surgical operations and procedures statistics. Eurostat.
        2016
        • Healthcare Cost and Utilization Project (HCUP)
        Surgeries in hospital-based ambulatory surgery and hospital inpatient settings.
        Agency for Healthcare Research and Quality, Rockville, MD2014
        • The Southern Surgeons Club
        A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club.
        New Engl J Med. 1991; 324: 1073-1078
        • Caputo L.
        • Aitken D.R.
        • Mackett M.C.
        • Robles A.E.
        Iatrogenic bile duct injuries. The real incidence and contributing factors—implications for laparoscopic cholecystectomy.
        Am Surg. 1992; 58: 766-771
        • Fletcher D.R.
        • Hobbs M.S.
        • Tan P.
        • et al.
        Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.
        Ann Surg. 1999; 229: 449-457
        • Huang X.
        • Feng Y.
        • Huang Z.
        Complications of laparoscopic cholecystectomy in China: an analysis of 39,238 cases.
        Chin Med J. 1997; 110: 704-706
        • Morgenstern L.
        • McGrath M.F.
        • Carroll B.J.
        • Paz-Partlow M.
        • Berci G.
        Continuing hazards of the learning curve in laparoscopic cholecystectomy.
        Am Surg. 1995; 61: 914-918
        • Waage A.
        • Nilsson M.
        Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the swedish inpatient registry.
        Arch Surg. 2006; 141: 1207-1213
        • Barrett M.
        • Asbun H.J.
        • Chien H.L.
        • Brunt L.M.
        • Telem D.A.
        Bile duct injury and morbidity following cholecystectomy: a need for improvement.
        Surg Endosc. 2017; https://doi.org/10.1007/s00464-017-5847-8
        • Archer S.B.
        • Brown D.W.
        • Smith C.D.
        • Branum G.D.
        • Hunter J.G.
        Bile duct injury during laparoscopic cholecystectomy: results of a national survey.
        Ann Surg. 2001; 234: 549-559
        • Flum D.R.
        • Koepsell T.
        • Heagerty P.
        • Sinanan M.
        • Dellinger E.P.
        Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error?.
        Arch Surg. 2001; 136: 1287-1292
        • The Southern Surgeons Club
        A prospective analysis of 1518 laparoscopic cholecystectomies.
        New Engl J Med. 1991; 324: 1073-1078
        • Strasberg S.M.
        • Hertl M.
        • Soper N.J.
        An analysis of the problem of biliary injury during laparoscopic cholecystectomy.
        J Am Coll Surg. 1995; 180: 101-125
        • Daly S.C.
        • Deziel D.J.
        • Li X.
        • et al.
        Current practices in biliary surgery: Do we practice what we teach?.
        Surg Endosc. 2016; 30: 3345-3350
        • Buddingh K.T.
        • Hofker H.S.
        • ten Cate Hoedemaker H.O.
        • van Dam G.M.
        • Ploeg R.J.
        • Nieuwenhuijs V.B.
        Safety measures during cholecystectomy: results of a nationwide survey.
        World J Surg. 2011; 35 (discussion 42-3): 1235-1241
        • Lange J.F.
        • Stassen L.P.S.
        Appendix d: “Best practice”: de techniek van de laparoscopische cholecystectomie (“critical view of safety”). Richtlijn Galsteenlijden: Nederlandse Vereninging voor Heelkunde.
        2016
        • Strasberg S.M.
        • Eagon C.J.
        • Drebin J.A.
        The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy—the danger of the false infundibulum.
        J Am Coll Surg. 2000; 191: 661-667
        • de Boer E.
        • Boerma D.
        • van Erpecum K.J.
        • et al.
        Evidence based guideline: diagnosis and treatment of cholelithiasis. Association of Surgeons of the Netherlands.
        2016
        • Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
        The SAGES Safe Cholecystectomy Program. Strategies for minimizing bile duct injuries: adopting a universal culture of safety in cholecystectomy.
        2015
        • Iwashita Y.
        • Hibi T.
        • Ohyama T.
        • et al.
        Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework?.
        J Hepatobiliary Pancreat Sci. 2017; 24: 591-602
        • Nijssen M.A.J.
        • Schreinemakers J.M.J.
        • Meyer Z.
        • van der Schelling G.P.
        • Crolla R.M.P.H.
        • Rijken A.M.
        Complications after laparoscopic cholecystectomy: a video evaluation study of whether the critical view of safety was reached.
        World J Surg. 2015; 39: 1798-1803
        • Massarweh N.N.
        • Devlin A.
        • Elrod J.A.
        • Symons R.G.
        • Flum D.R.
        Surgeon knowledge, behavior, and opinions regarding intraoperative cholangiography.
        J Am Coll Surg. 2008; 207: 821-830
        • Sanjay P.
        • Kulli C.
        • Polignano F.M.
        • Tait I.S.
        Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland.
        Ann R Coll Surg Engl. 2010; 92: 302-306
        • Hibi T.
        • Iwashita Y.
        • Ohyama T.
        • et al.
        The “right” way is not always popular: comparison of surgeons' perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan.
        J Hepatobiliary Pancreat Sci. 2017; 24: 24-32