SAGES Expert Delphi Consensus: Critical Factors For Safe Surgical Practice In Laparoscopic Cholecystectomy
P H Pucher, L. Michael Brunt, Robert Fanelli, Horacio J. Asbun, Rajesh Aggarwal
Published 2015 · Medicine
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BackgroundAlthough it has been 25 years since the introduction of laparoscopy to cholecystectomy, outcomes remain largely unchanged, with rates of bile duct injury higher in the modern age than in the era of open surgery. The SAGES Safe Cholecystectomy Task Force (SCTF) initiative seeks to encourage a culture of safety in laparoscopic cholecystectomy (LC) and reduce biliary injury. An expert consensus study was conducted to identify interventions thought to be most effective in pursuit of this goal.MethodsAn initial list of items for safer practice in LC was identified by the SCTF through a nominal group technique (NGT) process. These were put forward to 407 SAGES committee members in two-stage electronically distributed Delphi surveys. Consensus was achieved if at least 80 % of respondents ranked an item as 4 or 5 on a Likert scale of importance (1–5). Additionally, respondents ranked five top areas of importance for the following domains: training, assessment, and research.ResultsThirty-nine initial items were identified through NGT. Response rates for each Delphi round were 40.2 and 34 %, respectively. Final consensus was achieved on 15 items, the majority of which related to non-technical factors in LC. Key domains for training, assessment, and research were identified. Critical view of safety was deemed most important for overall safety, as well as training and assessment of LC. Intraoperative cholangiography was identified as an additional priority area for future research.ConclusionsConsensus items to progress surgical practice, training, assessment, and research have been identified, to promote safe practice and improve patient outcomes in LC.
This paper references
Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences.
Kenneth A. Kern (1997)
A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery
Annegret Borchard (2012)
The nominal group technique: a research tool for general practice?
M Gallagher (1993)
Comparative Operative Outcomes of Early and Delayed Cholecystectomy for Acute Cholecystitis: A Population-Based Propensity Score Analysis
Charles de Mestral (2014)
The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy
Anubhav Mishra (2007)
Risk management observations from litigation involving laparoscopic cholecystectomy.
Thomas R. Mclean (2006)
Safety Measures During Cholecystectomy: Results of a Nationwide Survey
Danny Rosin (2011)
Cause and Consequences
Robert B Smith (2011)
Long-term effects of iatrogenic bile duct injury during cholecystectomy.
Björn Törnqvist (2009)
Epidemiology of gallbladder stone disease
Eldon A. Shaffer (2006)
A comparison of laparoscopic and open treatment of acute cholecystitis
Stephen Unger (1993)
Profiles in laparoscopy: Mouret, Dubois, and Perissat: the laparoscopic breakthrough in Europe (1987-1988).
Litynski Gs (1999)
A simple effective method for generation of a permanent record of the Critical View of Safety during laparoscopic cholecystectomy by intraoperative "doublet" photography.
Dominic E. Sanford (2014)
15 Years of Litigation Following Laparoscopic Cholecystectomy in England
Kevin E. Behrns (2011)
[Iatrogenic damage of the bile ducts caused by cholecystectomy. Treatment and results].
M. Raute (1988)
Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis.
Frederik Keus (2006)
Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs
Nicole M Mealing (2010)
Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium
Benoît Navez (2012)
Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.
David R. Fletcher (1999)
Coelioscopic Cholecystectomy: Preliminary Report of 36 Cases
François Dubois (1990)
Gallstone disease: Epidemiology of gallbladder stone disease.
Eldon A. Shaffer (2006)
Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry.
Anne Waage (2006)
Causes and Prevention of Laparoscopic Bile Duct Injuries: Analysis of 252 Cases From a Human Factors and Cognitive Psychology Perspective
Lawrence W. Way (2003)
An analysis of the problem of biliary injury during laparoscopic cholecystectomy.
Steven M. Strasberg (1995)
The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database
Kirstine Moll Harboe (2010)
Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy.
David R. Flum (2003)
Surgical ward round quality and impact on variable patient outcomes
P H Pucher (2013)
Systematic Review of the Impact of Surgical Harm on Quality of Life After General and Gastrointestinal Surgery
George Bouras (2014)
Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival.
P H Pucher (2014)
Bile duct injuries during laparoscopic cholecystectomy
Douglas Olsen (1997)
Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment.
Laura C. Stewart (1995)
Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial
Anthony J Mcmahon (1994)
Development of a virtual reality training curriculum for laparoscopic cholecystectomy.
Rajesh Aggarwal (2009)
Introduction of surgical safety checklists in Ontario, Canada.
David R. Urbach (2014)
Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison.
Leon Morgenstern (1992)
Evaluation of Protocol Uniformity Concerning Laparoscopic Cholecystectomy in The Netherlands
L. S. G. L. Wauben (2007)
Laparoscopic cholecystectomy: first do no harm; second, take care of bile duct stones.
R. Cargill Hall (2013)
Rationale for the Fundamental Use of Surgical Energy™ (FUSE) curriculum assessment: focus on safety
Liane S. Feldman (2013)
Rationale and use of the critical view of safety in laparoscopic cholecystectomy.
Steven M. Strasberg (2010)
Treatment and results.
Roy Richard Grinker (1945)
This paper is referenced by
Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era
Christopher W. Mangieri (2018)
Tips and Tricks for Safe Cholecystectomy
Vinay Kumar Kapoor (2020)
Commentary: Intraoperative Management of Bile Duct Injuries by Non-biliary Surgeon
Mark P. Callery (2015)
Single-incision laparoscopic cholecystectomy using instrumental alignment in robotic single-site cholecystectomy
Sung Yub Jeong (2018)
How to Successfully Manage Residual Gallbladders Laparoscopically Following Open Techniques?
Anan Xu (2017)
Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy
L. Michael Brunt (2020)
Making the Diagnosis: Surgery, a Rational Approach to the Patient with Suspected CBD Stones
Robert Fanelli (2016)
Assessment of Competence in EVAR Procedures: A Novel Rating Scale Developed by the Delphi Technique.
Michael Strøm (2017)
Should high-frequency electrosurgery be discouraged during laparoscopic surgery?
Gustavo Lopes de Carvalho (2015)
Post-cholecystectomy Bile Duct Injury
Matthew P. Lungren (2020)
The Difficult Cholecystectomy
Nathaniel F.N. Stoikes (2020)
Direct Gallbladder Indocyanine Green Injection Fluorescence Cholangiography During Laparoscopic Cholecystectomy.
Claire E Graves (2017)
Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: a case-matched comparison
S. Quaresima (2019)
A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases 1
Peizhong Shang (2020)
Fluorescent incisionless cholangiography as a teaching tool for identification of Calot’s triangle
M. Roy (2016)
Achieving 90% Adoption of Clinical Practice Guidelines Using the Delphi Consensus Method in a Large Orthopedic Group.
Stefano A. Bini (2016)
Recommendations on the use of deep neuromuscular blockade by anaesthesiologists and surgeons. AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad) Consensus.
C. L. Errando-Oyonarte (2017)
Defining the key skills required to perform advanced laparoscopic procedures: a qualitative descriptive study
Elif Bilgiç (2020)
Key Components of the Safe Surgical Ward: International Delphi Consensus Study to Identify Factors for Quality Assessment and Service Improvement.
Yasmin A M Hassen (2018)
A New Era of Bile Duct Repair: Robotic-Assisted Versus Laparoscopic Hepaticojejunostomy
Adolfo Cuendis-Velázquez (2018)
Colecistectomía segura como un método de enseñanza
José Héctor Salazar-Gutiérrez (2016)
Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis
P H Pucher (2017)
Prevention of Bile Duct Injury During Cholecystectomy
Vinay Kumar Kapoor (2020)
Timing of Surgical Repair After Bile Duct Injury Impacts but Not Anastomotic Patency Postoperative Complications
Ismael Domínguez-Rosado (2016)
Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy ( FALCON trial )
Jacqueline van den Bos (2016)
Ten-year Audit of Safe Bail-Out Alternatives to the Critical View of Safety in Laparoscopic Cholecystectomy
D. Manatakis (2019)
Recomendaciones sobre el uso de bloqueo neuromuscular profundo por parte de anestesiólogos y cirujanos. Consenso AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad)
C. L. Errando-Oyonarte (2017)
Targeting Value-Driven Quality Improvement for Laparoscopic y in Michigan Cholecystectom
Kyle H. Sheetz (2018)
Development of an artificial intelligence system using deep learning to indicate anatomical landmarks during laparoscopic cholecystectomy
Tatsushi Tokuyasu (2020)
Laparoscopic Biliary Ultrasound
Steven P. Bowers (2020)
Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy.
Amin Madani (2015)
THE CRITICAL VIEW OF SAFETY PREVENTS THE APPEARANCE OF BILIARY INJURIES? ANALYSIS OF A SURVEY
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