Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis

Ohya, Hayato; Maeda, Atsuyuki; Takayama, Yoshiaki; Takahashi, Toshifumi; Seita, Kazuaki; Kikuchi, Yuji

doi:10.1111/ases.12969

Cited by 5 publications

(9 citation statements)

References 40 publications

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“…However, no study was randomised or adequately powered to detect significant differences in BDI between the described interventions. The quantitative analysis included 11 studies, with 10,938 cases (Table 1) [14][15][16][17][18][19][20][21][22][23][24]. These came from 7 hospitals affiliated with academic institutions and 4 district general hospitals, with an average annual volume between 45 and 420 laparoscopic cholecystectomies.…”

Section: Resultsmentioning

confidence: 99%

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

et al. 2022

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Background The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives. Method We systematically reviewed the literature (1995–2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI). Results 150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail‐out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS‐related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors). Conclusion Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail‐out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.

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Section: Resultsmentioning

confidence: 99%

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

et al. 2022

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“…Antithrombotic therapy itself was not a contraindication of LC. [16][17][18] All patients were preoperatively given a single intravenous dose of antibiotics.…”

Section: Methodsmentioning

confidence: 99%

“…19 2.1 | Surgical procedure Detailed surgical procedures were described in our previous reports. [16][17][18] In principle, we performed LC using the standard four-trocar method with hook-shaped electrocautery. When the inflammation around the GB was severe, we inserted an additional port and suction wand, which was manipulated by the right hand of the assistant to generate an auxiliary expanded field of view.…”

Section: Methodsmentioning

confidence: 99%

“…Patients who were not under any of these conditions were treated with LC. Antithrombotic therapy itself was not a contraindication of LC 16–18 …”

Section: Methodsmentioning

confidence: 99%

“…Detailed surgical procedures were described in our previous reports 16–18 . In principle, we performed LC using the standard four‐trocar method with hook‐shaped electrocautery.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of surgical outcomes of emergent laparoscopic cholecystectomy for acute cholecystitis between attending surgeons and senior residents: A propensity‐matched analysis

Ohya

Maeda

Takayama

et al. 2022

Asian J Endoscop Surgery

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Introduction: Emergent laparoscopic cholecystectomy (LC) is routinely performed for acute cholecystitis (AC) at our institution. This study was conducted to investigate the feasibility and safety of emergent LC for AC performed by senior residents.Materials and Methods: Data from 362 patients with AC who underwent emergent LC between January 2012 and June 2020 were retrospectively reviewed. Of these patients, 328 were operated on by senior residents (SR), and 34 were operated on by the attending surgeon (AS). Clinical characteristics and surgical and postoperative outcomes were compared between the SR and AS groups. Propensity score matching was used to minimize selection bias. When the operator was an SR, the LC was assisted by the AS.Results: Before matching, in the SR group, more patients had a history of abdominal surgery, and C-reactive protein and white blood cell counts were significantly higher. In the image findings, the minor axis of the gallbladder (GB) was longer, and the wall of the GB was thicker in the SR group. After propensity score matching, 28 pairs were identified. There were no significant differences in operative time (83 vs 88 minutes, P = .92), the amount of blood loss (25 vs 10 mL, P = .13), conversion to open surgery (3.6% vs 3.6%, P = 1), postoperative complications (7.2% vs 0%, P = .74), and postoperative hospital stay (4 vs 4 days, P = .87). Conclusion: Emergent LC for AC performed by SR under supervision appears to be feasible and safe.

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Preoperative difficulty factors in delayed laparoscopic cholecystectomy: Tokyo Guidelines 2018 surgical difficulty score analysis

Naito,

Suda,

Shinoda

et al. 2024

Asian J Endoscop Surgery

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IntroductionTokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for low‐risk acute cholecystitis (AC); however, some patients undergo delayed LC (DLC) after conservative treatment. DLC, influenced by chronic inflammation, is a difficult procedure. Previous studies on LC difficulty lacked objective measures. Recently, TG18 introduced a novel 25 findings difficulty score, which objectively assesses intraoperative factors. The purpose of this study was to use the difficulty score proposed in TG18 to identify and investigate the predictors of preoperative high‐difficulty cases of DLC for AC.MethodsWe retrospectively reviewed 100 patients with DLC after conservative AC treatment. The surgical difficulty of DLC was evaluated using a difficulty score. Based on previous studies, the highest scores in each category were categorized as grades A–C.ResultsThe severity of AC was mild in 51 patients and moderate in 49. Surgical outcomes revealed a distribution of difficulty scores, with grade C indicating high difficulty, showing significant differences in operative time, blood loss, achieving a critical view of safety, bailout procedures, and postoperative hospital stay compared with grades A and B. Regarding the preoperative risk factors, multivariate analysis identified age >61 years (p = .008), body mass index >27.0 kg/m2 (p = .007), and gallbladder wall thickness >6.2 mm (p = .001) as independent risk factors for grade C in DLC.ConclusionThe difficulty score proposed in TG18 provides an objective framework for evaluating surgical difficulty, allowing for more accurate risk assessments and improved preoperative planning in DLC for AC.

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Preoperative risk factors for technical difficulty in emergent laparoscopic cholecystectomy for acute cholecystitis

Cited by 5 publications

References 40 publications

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives

Comparison of surgical outcomes of emergent laparoscopic cholecystectomy for acute cholecystitis between attending surgeons and senior residents: A propensity‐matched analysis

Preoperative difficulty factors in delayed laparoscopic cholecystectomy: Tokyo Guidelines 2018 surgical difficulty score analysis

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