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ASSESSMENT OF THE CRITICAL VIEW OF SAFETY FROM ONLINE VIDEOS OF LAPAROSCOPIC CHOLECYSTECTOMY
Scott W. Schimpke*, Daniel J. Deziel, Benjamin R. Veenstra, John C. Kubasiak, Luu B. Minh
General Surgery, Rush University, Chicago, IL
Intro
Despite wide support for the critical view of safety (CVS) for anatomic identification during laparoscopic cholecystectomy (LC), there is an apparent disconnect with its application in practice. We previously demonstrated that only 25% of surgeons could correctly identify a written description of the CVS and that 21% could not identify an operative photograph of the CVS. The aim of this study was to evaluate achievement of the CVS in available online videos of LC.
Methods
Videos of LC published from 2008-2016 were identified via Google, Youtube, SAGES TV, Websurg and C-surgery searches. The videos were reviewed independently by four surgeons (3 attendings, one chief resident) who judged the CVS using the scoring system described by Strasberg for doublet photography. Public versus academic websites, single vs. multisite access, presence of acute cholecystitis, and principle angles for exposure were noted. Statistical analysis was performed using SPSS v. 23.0, Chicago, IL.
Results
73 videos were identified, with 41 from public and 32 from academic websites. There was good correlation between reviewers (Pearson coefficients 0.7-0.8). A satisfactory score for the CVS (5 or 6) was achieved in 62 of 292 (24%) video reviews. There were significant differences in demonstration of the CVS between: public vs. academic websites (16% vs. 33%, p=0.001), single site vs. multisite access (11% vs. 28%, p=0.004), and acute vs. non-acute cholecystitis (13% vs. 26%, p =0.047). Videos that demonstrated both anterior (ventral) and posterior (dorsal) dissection of the hepatocystic triangle attained the critical view more frequently (45%) than those with only anterior (13%) or caudal (3%) exposure, p=0.0001. The single CVS criterion that was least often fulfilled was dissection of the cystic plate.
Conclusion
The majority of LC videos available online do not satisfactorily achieve the CVS. While videos from academic websites perform better than public websites, two out of three are still unsatisfactory. Combined ventral and dorsal exposure of the hepatocystic triangle is advocated. If the CVS is to be understood and practiced, it must be properly demonstrated by video resources.
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