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Published in: Surgical Endoscopy 9/2020

01-09-2020 | Cholecystectomy | 2019 SAGES Oral

Improving attainment of the critical view of safety during laparoscopic cholecystectomy

Authors: Tetsuya Nakazato, Bailey Su, Stephanie Novak, Shanley B. Deal, Kristine Kuchta, Michael Ujiki

Published in: Surgical Endoscopy | Issue 9/2020

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Abstract

Introduction

We hypothesized that practicing surgeons would successfully achieve a better and more frequent Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) after participation in a structured Safe CVS Curriculum.

Methods

All surgeons performing LC at a regional health system had four LC cases recorded: twice before and twice after a curriculum focused on the CVS, which was led by a member of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Safe LC Task Force. Videos were then de-identified and randomly ordered for grading on a 6-point CVS assessment tool by two expert surgeons, who were blinded to the operator and whether the surgeries were performed before or after the curriculum. Confidence surveys and performance on a CVS identification video quiz were also compared pre- and post-curriculum.

Results

Twelve surgeons (five general, four acute care, and three minimally invasive) with an average experience of 17.9 ± 6.3 years participated in the study. After the curriculum, surgeons achieved all three CVS criteria in more cases (1/24 (4%) versus 10/24 (42%), p < 0.004). There was also significant improvement in correctly identifying whether the CVS was achieved in 10 video clips from the Internet (7.9 ± 1.5 vs. 9.3 ± 0.8, p = 0.006) and increased confidence on a 5-point Likert scale in accurately identifying the CVS (4.5 ± 0.5 vs. 4.9 ± 0.3, p = 0.017).

Conclusion

A structured curriculum on achieving a quality CVS for practicing, experienced surgeons improved their confidence and frequency of obtaining the Critical View of Safety during LC. We recommend that the Safe CVS Curriculum be considered for widespread use in order to increase the quality and frequency of attaining the Critical View of Safety.

Graphic abstract

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Metadata
Title
Improving attainment of the critical view of safety during laparoscopic cholecystectomy
Authors
Tetsuya Nakazato
Bailey Su
Stephanie Novak
Shanley B. Deal
Kristine Kuchta
Michael Ujiki
Publication date
01-09-2020
Publisher
Springer US
Keyword
Cholecystectomy
Published in
Surgical Endoscopy / Issue 9/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07178-y

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