Hannah Emily M, Bloom Matthew B, Schwaitzberg Steven D
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Surgery, Buffalo General Hospital, 100 High Street #D-3, Buffalo, NY, 14203, USA.
Surg Endosc. 2025 Sep 13. doi: 10.1007/s00464-025-12145-x.
Bile duct injuries (BDI) remain a rare but dreaded complication of laparoscopic cholecystectomy (LC). Proposed solutions to reduce BDI involve increased use of cholangiograms in patients with ambiguous anatomy. One explanation for the underutilization of intraoperative cholangiograms (IOC) is an unfamiliarity in interpreting cholangiograms, particularly amongst surgical trainees. We aim to gauge the current confidence levels and knowledge state of interpreting cholangiograms of surgeons at all levels of training.
Participants were screened based on their SAGES 2024 Annual Conference attendance and completed the "Cholangiogram Quiz" at a station in the SAGES Education & Innovation Center. Data were collected on training background, and confidence in identifying IOC findings. Participants (n = 88, surgical residents, fellows and attendings) completed eighteen multiple choice questions on interpreting a cholangiogram.
Overall quiz scores and confidence in interpreting IOC increased with level of training (p < 0.001). Out of normal IOC, aberrant ducts, BDI, common bile duct calculi, and filling defects, PGY1-5 residents were least confident identifying aberrant ducts, followed by BDI. PGY1-3 residents performed worse than attendings on questions on BDI (p < 0.001). Differences in quiz performance by training levels did not reach statistical significance for any other topic tested. Better quiz performance was directly correlated to more frequent use of IOC (p < 0.001). Higher confidence was associated with better quiz performance for all participants (p = 0.006). Confidence interpreting normal IOC and BDI on cholangiogram were directly correlated to quiz performance on these topics (normal IOC: p = 0.005, BDI: p = 0.047).
Participants with more advanced training, and who more frequently utilize IOC performed better on our quiz. Compared to other findings seen on IOC, residents failed to identify BDI. Surgical residents would benefit from targeted educational interventions to bolster confidence and improve accuracy in identifying BDI on IOC.
胆管损伤（BDI）仍然是腹腔镜胆囊切除术（LC）中一种罕见但可怕的并发症。为减少BDI而提出的解决方案包括增加对解剖结构不明确患者使用胆管造影。术中胆管造影（IOC）未得到充分利用的一个原因是对胆管造影解读不熟悉，尤其是外科住院医师。我们旨在评估各级培训水平的外科医生目前对胆管造影解读的信心水平和知识状态。
根据参与者参加2024年SAGES年会的情况进行筛选，并在SAGES教育与创新中心的一个站点完成“胆管造影测验”。收集有关培训背景以及识别IOC结果的信心的数据。参与者（n = 88，外科住院医师、研究员和主治医师）完成了18道关于胆管造影解读的多项选择题。
总体测验分数和对IOC解读的信心随着培训水平的提高而增加（p < 0.001）。在正常IOC、异常胆管、BDI、胆总管结石和充盈缺损中，PGY1 - 5住院医师对识别异常胆管最缺乏信心，其次是BDI。在关于BDI的问题上，PGY1 - 3住院医师的表现比主治医师差（p < 0.001）。对于所测试的任何其他主题，培训水平在测验表现上的差异均未达到统计学意义。更好的测验表现与更频繁使用IOC直接相关（p < 0.001）。对于所有参与者，更高的信心与更好的测验表现相关（p = 0.006）。对胆管造影上正常IOC和BDI的解读信心与这些主题的测验表现直接相关（正常IOC：p = 0.005，BDI：p = 0.047）。
接受更高级培训且更频繁使用IOC的参与者在我们的测验中表现更好。与IOC上看到的其他结果相比，住院医师未能识别出BDI。外科住院医师将受益于有针对性的教育干预，以增强信心并提高在IOC上识别BDI的准确性。
