Surgical endoscopy · 2026
Critical view of safety in laparoscopic cholecystectomy: a nationwide video-based benchmark of resident-performed cases.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Aguilera Matias, Becker Bernardita, Castiglioni Enzo, Sanhueza Diego, Rui-Wamba Jose, Grunauer Michelle, Achurra Pablo, Vildosola Cristobal, Jarry Cristian, Gaete María Inés, Varas Julian
Аннотация
BACKGROUND: The critical view of safety (CVS) is the standard for anatomic identification during laparoscopic cholecystectomy and is central to preventing bile duct injury. However, benchmarks for CVS achievement in resident-performed cases remain limited.
METHODS: We performed a nationwide cross-sectional review of 548 resident-performed laparoscopic cholecystectomy videos. Recordings were assessed asynchronously by trained raters using a secure remote workflow. The primary outcome was CVS achievement on blinded video review, scored against the three standard criteria. Main exposures were operative setting, case difficulty graded with a 5-level operative performance rating system (OPRS)-based rating, and technical performance assessed with the objective structured assessment of technical skill (OSATS). Cases with missing CVS data were excluded from rate calculations. Proportions were compared using chi-square tests, and multivariable logistic regression included emergency setting, OPRS, and OSATS.
RESULTS: CVS status was available for 513/548 recordings (93.6%), and CVS was achieved in 314/513 cases (61.2%). Among cases with operative setting data, CVS achievement was higher in elective than emergency procedures (270/421 [64.1%] vs 41/85 [48.2%]; p < 0.01). Achievement declined with complexity: OPRS 1, 66.5%; OPRS 2, 62.3%; OPRS 3, 56.3%; OPRS 4, 42.9%; and OPRS 5, 14.3% (p < 0.001). CVS achievement was associated with higher OSATS scores (19.4 vs 15.7; p < 0.001). In multivariable analysis, OSATS remained independently associated with CVS achievement (OR 1.21 per point; 95% CI 1.16-1.27; p < 0.001), the OPRS difficulty gradient persisted (OR 0.72 per level), and emergency setting was no longer significant.
CONCLUSION: CVS achievement during resident-performed laparoscopic cholecystectomy was modest and declined with increasing operative complexity. Lower emergency-case rates may partly reflect greater difficulty. CVS achievement was independently associated with technical performance, suggesting a skill component beyond anatomic complexity. Asynchronous video review is a feasible benchmarking strategy to support targeted supervision and training.
METHODS: We performed a nationwide cross-sectional review of 548 resident-performed laparoscopic cholecystectomy videos. Recordings were assessed asynchronously by trained raters using a secure remote workflow. The primary outcome was CVS achievement on blinded video review, scored against the three standard criteria. Main exposures were operative setting, case difficulty graded with a 5-level operative performance rating system (OPRS)-based rating, and technical performance assessed with the objective structured assessment of technical skill (OSATS). Cases with missing CVS data were excluded from rate calculations. Proportions were compared using chi-square tests, and multivariable logistic regression included emergency setting, OPRS, and OSATS.
RESULTS: CVS status was available for 513/548 recordings (93.6%), and CVS was achieved in 314/513 cases (61.2%). Among cases with operative setting data, CVS achievement was higher in elective than emergency procedures (270/421 [64.1%] vs 41/85 [48.2%]; p < 0.01). Achievement declined with complexity: OPRS 1, 66.5%; OPRS 2, 62.3%; OPRS 3, 56.3%; OPRS 4, 42.9%; and OPRS 5, 14.3% (p < 0.001). CVS achievement was associated with higher OSATS scores (19.4 vs 15.7; p < 0.001). In multivariable analysis, OSATS remained independently associated with CVS achievement (OR 1.21 per point; 95% CI 1.16-1.27; p < 0.001), the OPRS difficulty gradient persisted (OR 0.72 per level), and emergency setting was no longer significant.
CONCLUSION: CVS achievement during resident-performed laparoscopic cholecystectomy was modest and declined with increasing operative complexity. Lower emergency-case rates may partly reflect greater difficulty. CVS achievement was independently associated with technical performance, suggesting a skill component beyond anatomic complexity. Asynchronous video review is a feasible benchmarking strategy to support targeted supervision and training.