Critical view of safety in laparoscopic cholecystectomy: A prospective investigation from both cognitive and executive aspects

Abstract

BackgroundThe achievement rate of the critical view of safety during laparoscopic cholecystectomy is much lower than expected. This original study aims to investigate and analyze factors associated with a low critical view of safety achievement.Materials and MethodsWe prospectively collected laparoscopic cholecystectomy videos performed from September 2, 2021, to September 19, 2021, in Sichuan Province, China. The artificial intelligence system, SurgSmart, analyzed videos under the necessary corrections undergone by expert surgeons. Also, we distributed questionnaires to surgeons and analyzed them along with surgical videos simultaneously.ResultsWe collected 169 laparoscopic cholecystectomy surgical videos undergone by 124 surgeons, among which 105 participants gave valid answers to the questionnaire. Excluding those who conducted the bail-out process directly, the overall critical view of safety achievement rates for non-inflammatory and inflammatory groups were 18.18% (18/99) and 9.84% (6/61), respectively. Although 80.95% (85/105) of the surgeons understood the basic concept of the critical view of safety, only 4.76% (5/105) of the respondents commanded all three criteria in an error-free way. Multivariate logistic regression results showed that an unconventional surgical workflow (OR:12.372, P < 0.001), a misunderstanding of the 2nd (OR: 8.917, P < 0.05) and 3rd (OR:8.206, P < 0.05) criterion of the critical view of safety, and the don't mistake “fundus-first technique” as one criterion of the critical view of safety (OR:0.123, P < 0.01) were associated with lower and higher achievements of the critical view of safety, respectively.ConclusionsThe execution and cognition of the critical view of safety are deficient, especially the latter one. Thus, increasing the critical view of safety surgical awareness may effectively improve its achievement rate.

How to achieve the critical view of safety for safe laparoscopic cholecystectomy: Technical aspects

“…In a survey of 374 practicing surgeons belonging to the Midwest Surgical Association and SAGES, only 27% of the respondents practiced the CVS method, whereas many of them could not identify the CVS descriptively (75%) or visually (21%) [17]. In a recent study conducted in China, the correct execution and cognition of the CVS were found to be deficient in the majority of cases with very low CVS achievement rates (18.18% in a non-inflammatory group and 9.84% in an inflammatory group) [19]. In a Mexican study involving both practicing surgeons and surgical residents, although 95% (n = 708) participants reported that they knew the concept of CVS, only half (51%) could define the concept correctly [20].…”

“…Despite the description of CVS many decades back and uniform recommendation for its use, its poor understanding and low adoption rates among surgeons and trainees in routine general surgical practice remain global problems [16][17][18][19][20][21]. In a survey of 374 practicing surgeons belonging to the Midwest Surgical Association and SAGES, only 27% of the respondents practiced the CVS method, whereas many of them could not identify the CVS descriptively (75%) or visually (21%) [17].…”

“…Despite poor understanding and dismal adoption rates of CVS in routine practice at present, educational intervention and increasing awareness of CVS might improve its achievement rates during LC effectively [19,22]. Herein, a technique of achieving CVS during LC utilizing various anatomical landmarks is described with the aim to enhance its understanding among general surgery trainees and practicing general surgeons.…”