WHAT IS THE OPTIMAL TECHNIQUE FOR INTRAOPERATIVE CHOLANGIOGRAPHY (IOC) AND ARE THE TECHNIQUE AND THE FINDINGS OPTIMALLY RECORDED AT OUR INSTITUTION?
Rebecca Barnett*, Yousef Ibrahim, Kimberly Da Costa, Ashraf Rasheed
Surgery, Royal Gwent Hospital, Caerphilly, United Kingdom
Background: Limited evidence exists describing the optimum protocol for performing intraoperative cholangiography during laparoscopic cholecystectomy. Images saved during surgery often fail to highlight the necessary anatomical landmarks and operative documentation of the technique and findings is variable. Our aim was to identify the key characteristics of an optimal intraoperative cholangiography (IOC) and to evaluate current practice at our institution.
Methods: A literature search was conducted to identify quality indicators for performing IOC and documenting key findings. This was used to develop a standardised proforma for scoring IOC. Retrospective analysis was conducted of consecutive IOCs performed during elective laparoscopic cholecystectomy at a single institution. Visual documentation of 7 anatomical landmarks on the captured IOC images and textual reporting in the operation note was assessed.
Results: One hundred IOCs were evaluated. Only 32 (34%) of captured images had all 7 landmarks present. In all cases the operative text failed to refer to all 7 landmarks. There was a significant difference between landmarks that could be identified on the captured images and their documentation within the operative text.
Conclusions: This study suggests that IOC image capture of the 7 key anatomical landmarks and their textual reporting in this cohort is sub-optimal. We believe IOC technique, minimal data set for reporting and image capture should be standardised to allow better communication of findings and facilitate meaningful comparative research.
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