Critical view of safety in cholecystectomy is not a well disseminated concept. a web based analysis

Abstract

Background: Bile duct injury is an ominous complication after cholecystectomy. Critical view of safety (CVS) might help to identify the cystic duct and artery. The aim of this study is to analyze the frequency of CVS compliance in laparoscopic cholecystectomy videos available in the web. Methods: We searched YouTube platform using the following terms: “laparoscopic cholecystectomy” (LC) and “critical view of safety laparoscopic cholecystectomy” (CVSLC), both in English and Spanish. Videos were rated by an expert in bile duct surgery and a medical student who received prior training. We used the scale developed by Sanford and Strasberg to determine whether CVS was accomplished and Parkland scale to rate difficulty. Spearman correlation coefficients (SCC) were used to assess the degree of correlation between CVS compliance and difficulty measures. Results: Forty three videos with more than 50,000 visits were selected. Those from the U.S. had the highest number of visits (average 719,994). CVS was accomplished in 34.9% of the videos according to the assessment of both observers SCC 0.691 (p = 0.001). Only 4.7% of the videos analyzed by the expert and the student were classified as difficult cases with an agreement frequency of 95.3%. CVS component with the lowest frequency of compliance was dissection of the cystic plate with a rate of 8.3% of videos searched with the term LC and 57.9% with the term CVSLC (p = 0.001). Conclusion: CVS was not achieved by most videos analyzed in this study, despite the majority were easy cases. More effort is needed to disseminate CVS concept.Table 1Achievement of CVS by regionRegionVideos analyzedCVS fulfillmentLatin America155 (33.3%)United States of America31 (33.3%)Asia114 (36.3%)Europe71 (14.2%)Australia21 (50%)Africa21 (50%)CVS: Critical View of Safety. Open table in a new tab CVS: Critical View of Safety.