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Background: The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons., Methods: Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study., Results: The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P <0.001), but not in emergency LCCs (18.4% vs. 15.0%, P =0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P =0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged., Conclusions: Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions., Competing Interests: P.T. reports grants from Finska Läkaresällskapet and Victoriastiftelsen, outside the submitted work. L.K. reports grants from Mary et Georg Ehrnrooth’s Foundation and grants from the Finnish Cancer Foundation (Syöpäsäätiö), outside the submitted work. V.S. reports grants from Helsinki University Hospital research grants, during the conduct of the study and grants from Vatsatautien tutkimussäätiö Foundation, grants from Mary et Georg Ehrnrooth’s Foundation, grants from Academy of Finland, and grants from Finnish Cancer Foundation (Syöpäsäätiö), outside the submitted work. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Laparoscopic cholecystectomy (LCC) carries a 0.3-1.8% risk of bile duct injury (BDI). This study investigated if intraoperative photo documentation of the critical view of safety (CVS) is related to lower rates of BDIs and postoperative complications in LCC., Methods: Surgeons were instructed to take photos of the view before clipping the cystic duct and artery. Two independent raters scored the photos 0-6 using predefined criteria for CVS. Mean scores of ≥4.5 were satisfactory., Results: The study consisted of 1532 patients undergoing LCC between April 2018 and October 2019. CVS was satisfactory in 354 (23.1%), unsatisfactory in 823 (53.7%), and photos were missing in 355 (23.2%) patients. Patients with satisfactory CVS had the lowest BDI rate compared with unsatisfactory CVS or missing photos (0.3% vs. 1.0% vs. 2.3%, p = 0.012). Four major BDIs (Strasberg D-E) occurred, but none in patients with satisfactory CVS. Patients with satisfactory CVS had the lowest postoperative complication rate compared with patients with unsatisfactory CVS or without photos (4.8% vs. 7.9 vs. 9.9%, p = 0.011). Of patients with acute cholecystitis, 15.7% had satisfactory CVS, whereas 26.8% without cholecystitis had satisfactory CVS (p < 0.001)., Conclusion: Intraoperative photo documentation of satisfactory CVS is associated with lower rates of BDIs and complications., (Copyright © 2021 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Background: This study investigated how annual caseloads and the surgeon's previous experience influence the outcome in laparoscopic cholecystectomy (LCC) for acute cholecystitis., Methods: A total of 892 patients treated in Helsinki University Hospital in 2013-2016 were retrospectively analyzed. Surgeons were compared regarding volume-over 5 LCCs for acute cholecystitis a year versus 5 or fewer LCCs a year, and experience-attendings versus residents., Results: High-volume surgeons (n=14) operated faster than low-volume surgeons (n=62) (91 vs. 108 min, P<0.001). Examining only procedures with an attending present, high-volume attendings (n=7) converted less (14.9% vs. 32.0%, P<0.001) and operated faster (95 vs. 110 min, P<0.001) compared with low-volume attendings (n=41). The results of residents did not significantly differ from the results of attendings., Conclusions: Attending surgeons, performing >5 LCCs for acute cholecystitis a year, have shorter operative times and lower conversion rates.

Background: While 3D laparoscopy increases surgical performance under laboratory conditions, it is unclear whether it improves outcomes in real clinical scenarios. The aim of this trial was to determine whether the 3D laparoscopy can enhance surgical efficacy in laparoscopic cholecystectomy (LCC)., Method: This prospective randomized controlled study was conducted between February 2015 and April 2017 in a day case unit of an academic teaching hospital. Patients scheduled for elective LCC were assessed for eligibility. The exclusion criteria were: (1) planned secondary operation in addition to LCC, (2) predicted to be high-risk for conversion, and (3) surgeons with less than five previous 3D laparoscopic procedures. Patients were operated on by 12 residents and 3 attendings. The primary endpoint was operation time. All surgeons were tested for stereoaquity (Randot® stereotest). The study was registered in ClinicalTrials.gov (NCT02357589)., Results: A total of 210 patients were randomized; 105 to 3D laparoscopy and 104 to 2D laparoscopy. Median operation time as similar in the 3D and 2D laparoscopy groups (49 min vs. 48 min, p = 0.703). Operation times were similar in subgroup analyses for surgeon's sex (male vs. female), surgeon's status (resident vs. attending), surgeon's stereovision (stereopsis 10 vs. less than 10), surgeon's experience (performed 200 LCCs or below versus over 200 LCCs), or patient's BMI (≤ 25 vs. 25-30 vs. > 30). No differences in intra- or postoperative complications were noted between the 3D and 2D groups., Conclusion: 3D laparoscopy did not show any advantages over 2D laparoscopy in LCC.