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Background and Objectives: Many risk factors have been identified in minimally invasive cholecystectomies that lead to higher complications and conversion rates. No study that we encountered looked at nonvisualization of the gallbladder (GB) during surgery as a risk factor. We hypothesized that nonvisualization was associated with an increased risk of complications and could be an early intraoperative identifier of a higher risk procedure. Recognizing this could allow surgeons to be aware of potential risks and to be more likely to convert to open for the safety of the patient., Methods: We looked at minimally invasive cholecystectomies performed at our institution from January 2015 through April 2016 and had the performing resident fill out a survey after the surgery. Outcomes were conversion rates, intraoperative complications, and blood loss and were analyzed via Pearson χ 2 test or Mann-Whitney U test., Results: The primary outcome showed a conversion rate of 37% in nonvisualized GBs versus 0% in visualized ( P = .001). Secondary outcomes showed significant differences in GB perforations (74% vs 13%, P = .001), omental vessel bleeding (16% vs. 0%, P = .005), and EBL (46 mL vs 29 mL, P = .001)., Conclusions: Intraoperative nonvisualization of the GB after adequate positioning caused significantly increased risk of intraoperative complications and conversion. This knowledge could be useful during intraoperative assessment, to decide whether a case should be continued as a minimally invasive procedure or converted early to help reduce risk to the patient. Further randomized controlled studies should be performed to further demonstrate the value of this assessment.

Objective: To understand whether preoperative care of adolescent patients differs according to two different pediatric subspecialties with respect to patient pregnancy status, drug use, and patient assent. To understand how preoperative care of adolescent patients varies with length of practice and practice setting., Methods: A cross-sectional study surveyed 51 American Society of Pediatric Otolaryngology (ASPO) members and 108 American Pediatric Surgical Association (APSA) members. Outcomes included how often ('always', 'sometimes', 'never') participants ask adolescents (ages 12-18 years) about substance use, pregnancy, and assent for surgery. Differences according to physicians' practice duration and setting were also examined. Fisher's exact tests and Cochran-Armitage tests were applied for statistical analysis., Results: Although ASPO and APSA members did not differ significantly in how often they ask adolescent patients about pregnancy, ASPO members were more likely to 'always' cancel elective surgery in a pregnant patient (p<0.007). ASPO members were also more likely to 'always' ask about substance use, although this difference was not significant (p<0.06). APSA members were more likely to proceed with surgery despite an adolescent's refusal (p<0.007). Physicians in both specialties with <5 years in practice were most likely to 'always' ask about pregnancy, and physicians with fewer adolescent patients in their practice were more likely to 'always' ask about substance use. Physicians in differing practice settings varied in their responses about proceeding with elective surgery in a pregnant patient (p<0.03)., Conclusion: ASPO and APSA members differ in their preoperative management of adolescent patients. Newer physicians and those with fewer adolescent patients also differ from physicians with more extensive experience with adolescents., (Copyright © 2013. Published by Elsevier Ireland Ltd.)