Published online Mar 27, 2020. doi: 10.4240/wjgs.v12.i3.93
Peer-review started: October 17, 2019
First decision: December 4, 2019
Revised: December 19, 2019
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: March 27, 2020
Laparoscopic cholecystectomy (LC) is a minimally invasive procedure, often performed by surgical residents (SRs). Fluorescence cholangiography (FC) enables real-time identification of biliary anatomy.
To investigate the benefit of FC for enhancing SRs’ identification skills.
Prospective data was collected from January 2018 to June 2018 at our hospital. The study cohorts were the SRs (study group, n = 15) and the surgical staff (SS; control group, n = 9). Participants were assigned to watch videos of LCs with FC from five different patients who had gallbladder disease, and identify structures in the video clips (including cystic duct, common bile duct, common hepatic duct, and cystic artery), first without FC, and then with FC.
In the without-FC phase, the overall misidentification rate by SRs (21.7%) was greater than that of the SS (11.8%; P = 0.018), However, in the FC phase, the two groups did not significantly differ in misidentification rates (23.3% vs 23.3%, P = 0.99). Paired-structure analysis of the without-FC and with-FC phases for the SR group found a significantly higher misidentification rate in the without-FC phase than the with-FC phase (21.9% vs 10.9%; P < 0.01). However, misidentification rates in the with-FC phase did not significantly differ between SRs and SS.
FC enhanced identification skills of inexperienced surgeons during LC compared with conventional training. Combined with simulation-based video training, FC is a promising tool for enhancing technical and decision skills of trainees and inexperienced surgeons.
Core tip: Laparoscopic cholecystectomy (LC) is often performed by surgical residents. Avoiding bile duct injury (BDI) is a critical aspect of learning to perform this procedure safely. Landmark misperception is a high-risk factor for bile duct injury. Fluorescence cholangiography (FC) enables real-time identification of biliary anatomy during LC. We studied changes in biliary identification skills among surgical residents when FC was applied during LC, with staff surgeons as the control group. FC is a promising tool for enhancing biliary identification skills of surgeons-in-training.