Application of a novel surgical difficulty grading system during laparoscopic cholecystectomy

被引：14

作者：

Asai, Koji ^{[1
]}

Iwashita, Yukio ^{[2
]}

Ohyama, Tetsuji ^{[3
]}

Endo, Itaru ^{[4
]}

Hibi, Taizo ^{[5
]}

Umezawa, Akiko ^{[6
]}

Suzuki, Kenji ^{[7
]}

Watanabe, Manabu ^{[1
]}

Kurata, Masanao ^{[8
]}

Mori, Yasuhisa ^{[9
]}

Higashida, Masaharu ^{[10
]}

Kumamoto, Yusuke ^{[11
]}

Shindoh, Junichi ^{[12
]}

Yoshida, Masahiro ^{[13
]}

Honda, Goro ^{[14
]}

Misawa, Takeyuki ^{[15
]}

Abe, Yuta ^{[16
]}

Nagakawa, Yuichi ^{[17
]}

Toyota, Naoyuki ^{[18
]}

Yamada, Shigetoshi ^{[19
]}

Norimizu, Shinji ^{[20
]}

Matsumura, Naoki ^{[21
]}

Sata, Naohiro ^{[22
]}

Sunagawa, Hiroki ^{[23
]}

Ito, Masahiro ^{[24
]}

Takeda, Yutaka ^{[25
]}

Nakamura, Yoshiharu ^{[26
]}

Rikiyama, Toshiki ^{[27
]}

Higuchi, Ryota ^{[14
]}

Gocho, Takeshi ^{[28
]}

Honma, Yuki ^{[4
]}

Hirashita, Teijiro ^{[2
]}

Kanemoto, Hideyuki ^{[29
]}

Nozawa, Masayuki ^{[30
]}

Watanabe, Yusuke ^{[31
]}

Kohga, Atsushi ^{[7
]}

Yazawa, Takehisa ^{[14
]}

Tajima, Hiroshi ^{[11
]}

Nakahira, Shin ^{[32
]}

Asaoka, Tadafumi ^{[33
]}

Yoshioka, Ryuji ^{[34
]}

Fukuzawa, Junya ^{[35
]}

Fujioka, Shuichi ^{[36
]}

Hata, Daigo ^{[36
]}

Haruta, Hidenori ^{[22
]}

Asano, Yukio ^{[24
]}

Nomura, Ryohei ^{[21
]}

Matsumoto, Joe ^{[37
]}

Kameyama, Noriaki ^{[38
]}

Miyoshi, Atsushi ^{[39
]}

机构：

[1] Toho Univ, Dept Surg, Ohashi Med Ctr, Tokyo, Japan

[2] Oita Univ, Dept Gastroenterol & Pediat Surg, Fac Med, Oita, Japan

[3] Kurume Univ, Biostat Ctr, Fukuoka, Japan

[4] Yokohama City Univ, Dept Gastroenterol Surg, Grad Sch Med, Yokohama, Kanagawa, Japan

[5] Kumamoto Univ, Dept Pediat Surg & Transplantat, Grad Sch Med Sci, Kumamoto, Japan

[6] Yotsuya Med Cube, Minimally Invas Surg Ctr, Tokyo, Japan

[7] Fujinomiya City Gen Hosp, Dept Surg, Shizuoka, Japan

[8] Univ Tsukuba, Fac Med, Dept Gastrointestinal & Hepatobiliary Pancreat Su, Ibaraki, Japan

[9] Univ Occupat & Environm Hlth, Sch Med, Dept Surg 1, Fukuoka, Japan

[10] Kawasaki Med Sch, Dept Digest Surg, Okayama, Japan

[11] Kitasato Univ, Dept Gen Pediat & Hepatobiliary Pancreat Surg, Sch Med, Sagamihara, Kanagawa, Japan

[12] Toranomon Gen Hosp, Dept Gastroenterol Surg, Hepatobiliary Pancreat Surg Div, Tokyo, Japan

[13] Int Univ Hlth & Welf, Dept Hemodialysis & Surg, Ichikawa Hosp, Chiba, Japan

[14] Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan

[15] Teikyo Univ, Dept Surg, Sch Med, Tokyo, Japan

[16] Keio Univ, Dept Surg, Sch Med, Tokyo, Japan

[17] Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan

[18] Tsudanuma Cent Gen Hosp, Dept Surg, Chiba, Japan

[19] Tajimi City Hosp, Dept Surg, Gifu, Japan

[20] Japanese Red Cross Nagoya Daini Hosp, Dept Surg, Nagoya, Aichi, Japan

[21] Tohoku Rosai Hosp, Dept Surg, Sendai, Miyagi, Japan

[22] Jicji Med Univ, Dept Surg, Div Gastroenterol Gen & Transplant Surg, Shimotsuke, Tochigi, Japan

[23] Nakagami Hosp, Dept Surg, Noborikawa, Okinawa, Japan

[24] Fujita Hlth Univ, Dept Gastroenterol Surg, Bantane Hosp, Toyoake, Aichi, Japan

[25] Kansai Rosai Hosp, Dept Surg, Osaka, Japan

[26] Nippon Med Sch, Dept Gastrointestinal & Hepatobiliary Pancreat Su, Tokyo, Japan

[27] Jichi Med Univ, Saitama Med Ctr, Dept Surg, Saitama, Japan

[28] Jikei Univ, Dept Surg, Sch Med, Tokyo, Japan

[29] Shizuoka Prefectural Gen Hosp, Dept Gastroenterol Surg, Shizuoka, Japan

[30] Shimada Municipal Hosp, Dept Surg, Shizuoka, Japan

[31] Kyushu Univ, Grad Sch Med Sci, Dept Surg & Oncol, Fukuoka, Japan

[32] Sakai City Med Ctr, Dept HepatoBiliary Pancreat Surg, Osaka, Japan

[33] Osaka Police Hosp, Dept Gastroenterol Surg, Osaka, Japan

[34] Juntendo Univ, Dept Hepatobiliary Pancreat Surg, Sch Med, Tokyo, Japan

[35] Ibaraki Seinan Med Ctr Hosp, Dept Gastroenterol Surg, Ibaraki, Japan

[36] Jikei Univ, Dept Surg, Kashiwa Hosp, Chiba, Japan

[37] Obihiro Kosei Hosp, Dept Surg, Obihiro, Hokkaido, Japan

[38] KKR Tachikawa Hosp, Dept Digest Surg, Tokyo, Japan

[39] Saga Ken Med Ctr Koseikan, Dept Gastroenterol Surg, Saga, Japan

[40] Natl Hosp Org Tokyo Med Ctr, Dept Surg, Tokyo, Japan

[41] Tokyo Metropolitan Komagome Hosp, Dept Hepatobiliary Pancreat Surg, Tokyo, Japan

[42] Tohoku Univ, Dept Surg, Sch Med, Sendai, Miyagi, Japan

[43] Nippon Med Sch, Dept Gastroenterol Surg, Chibahokusoh Hosp, Chiba, Japan

[44] Kyoto Prefectural Univ Med, Dept Gastroenterol Surg, Kyoto, Japan

[45] Sainokuni Higashiomiya Med Ctr, Dept Surg, Saitama, Japan

来源：

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES | 2022年 / 29卷 / 07期

关键词：

acute cholecystitis; bile duct injury; laparoscopic cholecystectomy; surgical difficulty; vasculobiliary injury; ACUTE CHOLECYSTITIS; TOKYO GUIDELINES; MANAGEMENT; AGREEMENT;

D O I：

10.1002/jhbp.1068

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background Prevention of bile duct injury and vasculo-biliary injury while performing laparoscopic cholecystectomy (LC) is an unsolved problem. Clarifying the surgical difficulty using intraoperative findings can greatly contribute to the pursuit of best practices for acute cholecystitis. In this study, multiple evaluators assessed surgical difficulty items in unedited videos and then constructed a proposed surgical difficulty grading. Methods We previously assembled a library of typical video clips of the intraoperative findings for all LC surgical difficulty items in acute cholecystitis. Fifty-one experts on LC assessed unedited surgical videos. Inter-rater agreement was assessed by Fleiss's kappa and Gwet's agreement coefficient (AC). Results Except for one item ("edematous change"), kappa or AC exceeded 0.5, so the typical videos were judged to be applicable. The conceivable surgical difficulty gradings were analyzed. According to the assessment of difficulty factors, we created a surgical difficulty grading system (agreement probability = 0.923, kappa = 0.712, 90% CI: 0.587-0.837; AC(2) = 0.870, 90% CI: 0.768-0.972). Conclusion The previously published video clip library and our novel surgical difficulty grading system should serve as a universal objective tool to assess surgical difficulty in LC.

引用

页码：758 / 767

页数：10

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