Evidence map›Paper›PMID 37973638›Full record

ArticleSurgical endoscopy2024

A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety.

Gina Adrales, Francesco Ardito, Pradeep Chowbey, Salvador Morales-Conde, Alberto R Ferreres, Chrys Hensman, David Martin, Hanno Matthaei, Bruce Ramshaw, J Keith Roberts and 5 more

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 2 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 11 institutions in 9 countries.

Gina AdralesDivision of Minimally Invasive Surgery, Minimally Invasive Surgical Training and Innovation Center (MISTIC), Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA. gadrale1@jhmi.edu.
Francesco ArditoHepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy.
Pradeep ChowbeyInstitute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India.
Salvador Morales-CondeUnit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain.
Alberto R FerreresDepartment of Surgery, University of Buenos Aires, Buenos Aires, Argentina.
Chrys HensmanMonash University Department of Surgery & Lap Surgery, Melbourne, Australia.
David MartinDivision of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, USA.
Hanno MatthaeiDepartment of Surgery, University Medical Center Bonn, Bonn, Germany.
Bruce RamshawCQInsights PBC, Knoxville, TN, USA.
J Keith RobertsLiver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK.
Harald SchremGeneral, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria.
Anil SharmaInstitute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India.
Stephen TabiriTamale Teaching Hospital, University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana.
Eric VibertCentre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France.
Michael S WoodsCaresyntax Corporation, Boston, USA.
Boston University · USMax Super Speciality Hospital · INAssistance Publique – Hôpitaux de Paris · FRIstituti di Ricovero e Cura a Carattere Scientifico · ITJohns Hopkins Hospital · USMedical University of Graz · ATMonash University · AUTamale Teaching Hospital · GHUniversity Hospitals Birmingham NHS Foundation Trust · GBUniversity of Buenos Aires · ARUniversity of Minnesota · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American Board of Surgery's entrustable professional activities (EPAs) initiative. To enhance instrument development, a feasibility study was performed to elucidate expert surgeon perspectives regarding "safe" vs. "unsafe" practice.

methodsA multi-national consortium of 11 expert LC surgeons were asked to apply the LC-CVS OPSA to ten LC videos of varying surgical difficulty using a "safe" vs. "unsafe" scale. Raters were asked to provide written rationale for all "unsafe" ratings and invited to provide additional feedback regarding instrument clarity. A qualitative analysis was performed on written responses to extract major themes.

resultsOf the 660 ratings, 238 were scored as "unsafe" with substantial variation in distribution across tasks and raters. Analysis of the comments revealed three major categories of "unsafe" ratings: (a) inability to achieve the critical view of safety (intended outcome), (b) safe task completion but less than optimal surgical technique, and (c) safe task completion but risk for potential future complication. Analysis of reviewer comments also identified the potential for safe surgical practice even when CVS was not achieved, either due to unusual anatomy or severe pathology preventing safe visualization. Based upon findings, modifications to the instructions to raters for the LC-CVS OPSA were incorporated to enhance instrument reliability.

conclusionsA safety-based LC-CVS OPSA has the potential to significantly improve surgical training by incorporating CVS formally into learner assessment. This study documents the perspectives of expert biliary tract surgeons regarding clear identification and documentation of unsafe surgical practice for LC-CVS and enables the development of training materials to improve instrument reliability. Learnings from the study have been incorporated into rater instructions to enhance instrument reliability.

Indexed as

Cholecystectomy, LaparoscopicSurgeonsClinical CompetenceHumansReproducibility of ResultsVideo RecordingCompetency-based educationCritical view of safetyLaparoscopic cholecystectomyObjective procedure-specific assessmentSurgical trainingVideo-based assessment

Identifiers

PMID37973638
OpenAlexW4388722509

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.