The “right” way is not always popular: comparison of surgeons’ perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan
- Affiliated Author(s)
- 안근수
- Alternative Author(s)
- Ahn, Keun Soo
- Journal Title
- Journal of Hepato-Biliary-Pancreatic Sciences
- ISSN
- 1868-6974
- Issued Date
- 2017
- Keyword
- Acute cholecystitis; Critic al view of safety; Laparoscopic cholecystectomy; SS-Inner theory; Surgical difficulty
- Abstract
- Background Generally, surgeons’ perceptions of surgical safety are based on
experience and institutional policy. Our recent pilot survey demonstrated that the
acceptable duration of surgery and criteria for open conversion during laparoscopic
cholecystectomy (LC) vary among workplaces.
Methods A web-based survey was distributed to 554 expert LC surgeons in Japan,
Korea, and Taiwan. The questionnaire covered LC experience, safety measures and
recognition of landmarks, decision-making regarding conversion to open/partial
cholecystectomy and the implications of this decision. Overall responses were
compared among nations, and then stratified by LC experience level (lifetime cases
200–499, 500–999, and ≥1,000).
Results The response rate was 92.6% (513/554); 67 surgeons with ≤199 LCs were
excluded, and responses from 446 surgeons were analyzed. We observed significant
differences among nations on almost all questions. Differences that remained after
stratification by LC experience were on questions related to acceptable duration of
surgery, adoption rates of intraoperative cholangiography, the “critical view of safety”
technique, identification of Rouvi
ere’s sulcus, recognition of the SS-Inner layer theory,
and intraoperative judgment to abandon conventional LC.
Conclusions Even among experts, surgeons’ perceptions during LC are workplace-
dependent. A novel grading system of surgical difficult y and standardized LC
procedures are paramount to generate high-level evidence.
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