The effect of checklists on the surgical performance during laparoscopic cholecystectomy: A systematic review

Abstract

Laparoscopic cholecystectomy (LC) is known to be one of the most widely performed general surgical operations. However, it is associated with an increased incidence and severity of complications especially during the period of a surgeon's proficiency-gain curve. Certain complications could be prevented by decreasing the incidence and consequences of surgeon errors. We aimed to systematically review the application of checklists during LC and their effect on the surgical task performance. A systematic review was performed in compliance with the PRISMA guidelines. A search was performed on PubMed, ScienceDirect and the Cochrane-Library databases. English language articles published to November 2020 were included in this study. The terms included: ‘Checklist and laparoscopic cholecystectomy’, ‘checklist and laparoscopic surgery’, ‘checklist and cholecystectomy’ and checklist and minimally invasive surgery’’. MERSQI score was applied for quality assessment. The research protocol was registered with PROSPERO register (CRD42021209118). The systematic search resulted in 8862 citations, of which 23 relevant citations were assessed for eligibility. A final 9 articles (1079 procedures) were included. The endpoints were equipment-related-risk events, numbers and types of adverse events, rate of conversion to open cholecystectomy, team communication and coordination, the number of consequential and inconsequential errors. MERSQI mean score was 10.8 (range 5 to 13). The positive effect of checklists on the performance during LC was supported with 5 high-quality studies. The effect of the checklists application during LC showed a significant improvement of the surgical task performance by decreasing the surgeons’ errors. A combination of pre-operative safety and intra-procedural checklists can be the subject of future research for possible application during routine laparoscopic cholecystectomy.