Intraoperative Time-Out to Promote the Implementation of the Critical View of Safety in Laparoscopic Cholecystectomy: A Video-Based Assessment of 343 Procedures - 22/09/21
, María Rita Rodríguez-Luna, MD b, Takeshi Urade, MD, PhD c, Emanuele Felli, MD d, Patrick Pessaux, MD, PhD d, Didier Mutter, MD, PhD, FACS b, c, d, Jacques Marescaux, MD, FACS, (Hon) FRCS, (Hon) FJSES b, Guido Costamagna, MD, FACG, FJGES e, f, Bernard Dallemagne, MD b, c, d, Nicolas Padoy, PhD a, cAbstract |
Background |
The critical view of safety (CVS) is poorly adopted in surgical practices, although it is recommended ubiquitously to prevent major bile duct injuries during laparoscopic cholecystectomy (LC). This study aimed to investigate whether performing a short intraoperative time-out can improve CVS implementation.
Study Design |
In this before vs after study, surgeons performing LCs at an academic center were invited to use a 5-second long time-out to verify CVS before dividing the cystic duct (5-second rule). The primary aim was to compare the rate of CVS achievement for LC performed in the year before vs the year after implementation of the 5-second rule. The CVS achievement rate was computed after exclusion of bailout procedures using a mediated video-based assessment made by 2 independent reviewers. Clinical outcomes, LC workflows, and postoperative reports were also compared.
Results |
Three hundred and forty-three of 381 LC performed between December 2017 and November 2019 (171 before and 172 after implementation of the 5-second rule) were analyzed. The 5-second rule was associated with a significantly increased rate of CVS achievement (15.9% vs 44.1% before vs after the 5-second rule, respectively; p < 0.001). Significant differences were also observed with respect to the rate of bailout procedures (8.2% vs 15.7%; p = 0.04), median time (hours:minutes:seconds) to clip the cystic duct or artery (00:17:26; interquartile range 00:11:48 to 00:28:35 vs 00:23:12; interquartile range 00:14:29 to 00:31:45 duration; p = 0.007), and the rate of postoperative CVS reporting (1.3% vs 28.8%; p < 0.001). Postoperative morbidity was comparable (1.8% vs 2.3%; p = 0.68).
Conclusions |
Performing a short intraoperative time-out was associated with an improved CVS achievement rate. Systematic intraoperative cognitive aids should be studied to sustain the uptake of guidelines.
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Abbreviations and Acronyms : BDI, CVS, IQR, LC, QI, VBA
Plan
| CME questions for this article available at jacscme.facs.org |
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| Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. Ronald J Weigel, CME Editor, has nothing to disclose. |
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| Disclosures outside the scope of this work: Prof Costamagna’s institute receives grant funding from Boston Scientific and Prof Costamagna is a paid advisory committee/review panel member for Olympus and Cook Endoscopy. Prof Marescaux is the president of the Research Institute Against Digestive Cancer (IRCAD), which is partly funded by Karl Storz and Medtronic. Prof Padoy is a paid scientific advisor to Caresyntax. Prof Padoy’s institute receives PhD fellowship funding from Intuitive Surgical. Other authors have nothing to disclose. |
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| Support: This study is partially supported by a grant from The European Association for Endoscopic Surgery Research and by French state funds managed by the Agence Nationale de la Recherche (ANR) National Research Agency through the Investissements d’Avenir (Investments for the Future) Program under the ANR-10-IAHU-02 (IHU-Strasbourg) grant. |
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| A preprint version of this manuscript was originally published via arXiv.org on 4/6/2021: 2104.02338 |
Vol 233 - N° 4
P. 497-505 - octobre 2021 Retour au numéro
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