ArticleSurgical endoscopy2026
Critical view of safety in laparoscopic cholecystectomy: a nationwide video-based benchmark of resident-performed cases.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe 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.
methodsWe 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.
resultsCVS 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.
conclusionCVS 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.
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