An opportunity in difficulty: Japan–Korea–Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

Yukio Iwashita, Taizo Hibi, Tetsuji Ohyama, Goro Honda, Masahiro Yoshida, Fumihiko Miura, Tadahiro Takada, Ho Seong Han, Tsann Long Hwang, Satoshi Shinya, Kenji Suzuki, Akiko Umezawa, Yoo Seok Yoon, In Seok Choi, Wayne Shih Wei Huang, Kuo Hsin Chen, Manabu Watanabe, Yuta Abe, Takeyuki Misawa, Yuichi NagakawaDong Sup Yoon, Jin Young Jang, Hee Chul Yu, Keun Soo Ahn, Song Cheol Kim, In Sang Song, Ji Hoon Kim, Sung Su Yun, Seong Ho Choi, Yi Yin Jan, Yan Shen Shan, Chen Guo Ker, De Chuan Chan, Cheng Chung Wu, King Teh Lee, Naoyuki Toyota, Ryota Higuchi, Yoshiharu Nakamura, Yoshiaki Mizuguchi, Yutaka Takeda, Masahiro Ito, Shinji Norimizu, Shigetoshi Yamada, Naoki Matsumura, Junichi Shindoh, Hiroki Sunagawa, Takeshi Gocho, Hiroshi Hasegawa, Toshiki Rikiyama, Naohiro Sata, Nobuyasu Kano, Seigo Kitano, Hiromi Tokumura, Yuichi Yamashita, Goro Watanabe, Kunitoshi Nakagawa, Taizo Kimura, Tatsuo Yamakawa, Go Wakabayashi, Rintaro Mori, Itaru Endo, Masaru Miyazaki, Masakazu Yamamoto

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. Methods: Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0–6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median ± 1 after stratification by workplace and LC experience level. Results: Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. ‘Diffuse scarring in the Calot's triangle area’ in the ‘Factors related to inflammation of the gallbladder’ category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. Conclusions: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

Original languageEnglish
Pages (from-to)191-198
Number of pages8
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume24
Issue number4
DOIs
Publication statusPublished - 2017 Apr 1

Keywords

  • Acute cholecystitis
  • Delphi consensus
  • Laparoscopic cholecystectomy
  • Surgical difficulty

ASJC Scopus subject areas

  • Medicine(all)

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