Adequacy of Safe Laparoscopic Cholecystectomy Topics in Surgical Textbook: A Systematic Survey and Suggestions for Improvement

Abstract

Introduction: The ultimate goal of laparoscopic cholecystectomy is to finish the surgery safely. Safety precautions have been advocated but the attitude toward these safety issues is still varied among surgeons. The traditional teaching of laparoscopic cholecystectomy emphasized more on technical skills including procedural steps and dissection techniques. Surgical textbooks are still considered the source of information for medical students and surgical residents. It should cover fundamental aspects of surgery, including its safety precautions. Method: We formulated a comprehensive set of topics, related to safe laparoscopic cholecystectomy (anatomy, critical view of safety, 3-step conceptual roadmap, bailout strategy) to assess the adequacy of textbooks in common use. We assessed 12 surgical textbooks widely available to students in Indonesia, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information. Results: The maximum score that a book could achieve was 50. Most textbooks adequately describe the traditional teaching of anatomy, procedural steps, and dissection technique. Half of the reviewed textbooks describe the Critical View of Safety, but only its superficial aspects. Inflictions points including timeout and checklist and bailout strategy were not adequately described. Conclusions: Surgical textbook covers the essential topic of laparoscopic cholecystectomy, mainly on the technical aspect, and still not adequately described its non-technical part. Systematic revision of current textbooks might improve knowledge and practice toward a safety attitude of surgical procedure.