Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan.
J Hepatobiliary Pancreat Sci. 2021 Mar;28(3):255-262. doi: 10.1002/jhbp.871. Epub 2021 Jan 28.
To explore best practices for acute cholecystitis, it is necessary to construct a system to assess the difficulty of laparoscopic cholecystectomy (LC) based on intraoperative findings. In this study, multiple evaluators assessed videos of LC to assemble a library of typical video clips for 25 intraoperative findings.
We have previously identified 25 items that contribute to surgical difficulty in LC. For each item, roughly 30-second video clips were submitted from videos of LC performed at member institutions. We then selected one typical video from the collected clips based on simple tabulation of the instances of agreement. Inter-rater agreement was assessed with Fleiss's κ and Gwet's agreement coefficient (AC).
Except in the case of two assessment items ("edematous change" and "easy bleeding"), κ or AC significantly exceeded 0.5 and the typical videos were judged to be applicable. For the two remaining items, the evaluation was repeated after clarifying the definitions of positive and negative findings. Eventually, they were recognized as typical. The completed video clip library contains 31 clips and is divided into five categories (http://www.jshbps.jp/modules/project/index.php?content_id=13).
This clip library may be highly useful in clinical settings as a more objective standard for assessing surgical difficulty in LC.
为了探索急性胆囊炎的最佳治疗方法，有必要构建一个基于术中发现来评估腹腔镜胆囊切除术 (LC) 难度的系统。在本研究中，多位评估者评估了 LC 的视频，以汇编 25 种术中发现的典型视频片段库。
我们之前已经确定了 25 项有助于 LC 手术难度的项目。对于每个项目，从成员机构进行的 LC 视频中提交了大约 30 秒的视频片段。然后，根据简单的一致性计数，从收集的片段中选择一个典型的视频。使用 Fleiss 的 κ 和 Gwet 的一致性系数 (AC) 评估组内一致性。
除了“水肿改变”和“易出血”这两个评估项目外，κ 或 AC 显著超过 0.5，并且认为典型视频是适用的。对于其余的两个项目，在澄清了阳性和阴性发现的定义后，对评估进行了重复。最终，它们被确认为典型。完成的视频片段库包含 31 个片段，分为五类（http://www.jshbps.jp/modules/project/index.php?content_id=13）。
这个视频片段库可能在临床环境中非常有用，作为评估 LC 手术难度的更客观标准。
