Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
J Hepatobiliary Pancreat Sci. 2022 Jul;29(7):758-767. doi: 10.1002/jhbp.1068. Epub 2021 Nov 24.
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.
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 κ and Gwet's agreement coefficient (AC).
Except for one item ("edematous change"), κ 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, κ = 0.712, 90% CI: 0.587-0.837; AC = 0.870, 90% CI: 0.768-0.972).
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.
在进行腹腔镜胆囊切除术（LC）时，预防胆管损伤和血管胆道损伤是一个尚未解决的问题。术中发现可明确手术难度，有助于寻求急性胆囊炎的最佳治疗方案。本研究中，多名评估者对未经编辑的视频中的手术难度项目进行评估，然后构建了一个建议的手术难度分级。
我们之前组建了一个包含急性胆囊炎 LC 所有手术难度项目的术中发现典型视频剪辑库。51 名 LC 专家评估了未经编辑的手术视频。Fleiss's κ 和 Gwet 的一致性系数（AC）评估了组内一致性。
除了一项（“水肿改变”）外，κ 或 AC 均大于 0.5，因此认为典型视频是适用的。对可想象的手术难度分级进行了分析。根据对困难因素的评估，我们创建了一个手术难度分级系统（一致概率=0.923，κ=0.712，90%CI：0.587-0.837；AC=0.870，90%CI：0.768-0.972）。
之前发表的视频剪辑库和我们新的手术难度分级系统应作为评估 LC 手术难度的通用客观工具。
