The “right” way is not always popular: comparison of surgeons’ perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan

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...

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Published in:Journal of hepato-biliary-pancreatic sciences 2017-01, Vol.24 (1), p.24-32
Main Authors: Hibi, Taizo, Iwashita, Yukio, Ohyama, Tetsuji, Honda, Goro, Yoshida, Masahiro, Takada, Tadahiro, Han, Ho‐Seong, Hwang, Tsann‐Long, Shinya, Satoshi, Suzuki, Kenji, Umezawa, Akiko, Yoon, Yoo‐Seok, Choi, In‐Seok, Huang, Wayne Shih‐Wei, Chen, Kuo‐Hsin, Miura, Fumihiko, Watanabe, Manabu, Abe, Yuta, Misawa, Takeyuki, Nagakawa, Yuichi, Yoon, Dong‐Sup, Jang, Jin‐Young, Yu, Hee Chul, Ahn, Keun Soo, Kim, Song Cheol, Song, In Sang, Kim, Ji Hoon, Yun, Sung Su, Choi, Seong Ho, Jan, Yi‐Yin, Sheen‐Chen, Shyr‐Ming, Shan, Yan‐Shen, Ker, Chen‐Guo, Chan, De‐Chuan, Wu, Cheng‐Chung, Toyota, Naoyuki, Higuchi, Ryota, Nakamura, Yoshiharu, Mizuguchi, Yoshiaki, Takeda, Yutaka, Ito, Masahiro, Norimizu, Shinji, Yamada, Shigetoshi, Matsumura, Naoki, Shindoh, Junichi, Sunagawa, Hiroki, Gocho, Takeshi, Hasegawa, Hiroshi, Rikiyama, Toshiki, Sata, Naohiro, Kano, Nobuyasu, Kitano, Seigo, Tokumura, Hiromi, Yamashita, Yuichi, Watanabe, Goro, Nakagawa, Kunitoshi, Kimura, Taizo, Yamakawa, Tatsuo, Wakabayashi, Go, Endo, Itaru, Miyazaki, Masaru, Yamamoto, Masakazu
Format: Article
Language:English
Subjects:
Acute cholecystitis
Attitude of Health Personnel
Blood Loss, Surgical - physiopathology
Cholecystectomy
Cholecystectomy, Laparoscopic - adverse effects
Cholecystectomy, Laparoscopic - methods
Cholecystitis, Acute - diagnosis
Cholecystitis, Acute - surgery
Critical view of safety
Cross-Sectional Studies
Female
Humans
Internationality
Japan
Laparoscopic cholecystectomy
Laparoscopy
Laparotomy - adverse effects
Laparotomy - methods
Male
Operative Time
Patient Safety - statistics & numerical data
Postoperative Complications - epidemiology
Postoperative Complications - physiopathology
Republic of Korea
SS‐Inner theory
Surgeons
Surgeons - statistics & numerical data
Surgical difficulty
Surveys and Questionnaires
Taiwan
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Summary: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 Rouvière'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 difficulty and standardized LC procedures are paramount to generate high‐level evidence. HighlightIn this multinational survey on variability in surgical strategy among laparoscopic cholecystectomy experts, Hibi and colleagues found significant differences in acceptable surgical duration, adoption of safety measures, recognition of anatomical landmarks, and intraoperative conversion to open/partial cholecystectomy. Surgeons’ perceptions were workplace‐dependent, illustrating the need for a new grading system of surgical difficulty.
ISSN:1868-6974
1868-6982
DOI:10.1002/jhbp.417