Preoperative prediction model for critical view of safety achievement in laparoscopic cholecystectomy: a retrospective cohort study.

IF 3.3 2区医学 Q2 SURGERY

Surgical Endoscopy And Other Interventional Techniques Pub Date : 2026-10-12 DOI:10.1007/s00464-026-13421-0

Takahiro Gunji, Naokazu Chiba, Hirotaka Kojima, Ryota Suda, Hiroki Yamaguchi, Shoma Iida, Kanami Iwama, Takumi Seichi, Yoshihiro Nagae, Hiroyuki Higuchi, Akitoshi Ando, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Shigeto Ochiai, Toshimichi Kobayashi, Toru Sano, Koichi Tomita, Satoshi Tabuchi, Tetuo Ishizaki, Eiji Hidaka, Kisyo Mihara, Shigeyuki Kawachi

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引用次数: 0

Abstract

Background: We developed and validated a preoperative model to predict the difficulty in achieving the critical view of safety (CVS) during laparoscopic cholecystectomy (LC).

Methods: Patients who underwent LC with preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography between January 2015 and December 2023 were retrospectively analyzed and randomly assigned to derivation and validation cohorts (8:2). Surgical difficulty was defined as failure to achieve CVS. Logistic regression analysis was used to identify independent predictors. Model performance was evaluated using the area under the receiver operating characteristic curve and Brier score.

Results: Independent preoperative risk factors included age ≥ 65 years, American Society of Anesthesiologists physical status ≥ 3, preoperative endoscopic gallbladder drainage or stenting, CT attenuation of the CVS window ≥ - 26 HU, and common bile duct disruption on magnetic resonance cholangiopancreatography (all p < 0.05). The prediction score (0-13) demonstrated an area under the receiver operating characteristic curve of 0.732 (95% confidence interval 0.528-0.936) in the validation cohort. Risk stratification identified low-, moderate-, and high-risk groups with increasing rates of failure to achieve CVS.

Conclusions: This preoperative imaging-based scoring system may help predict CVS failure in LC and guide surgical decision-making.

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来源期刊

Surgical Endoscopy And Other Interventional Techniques 医学-外科

CiteScore

6.10

自引率

12.90%

发文量

890

审稿时长

6 months

期刊介绍： Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research. Topics covered in the journal include: -Surgical aspects of: Interventional endoscopy, Ultrasound, Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, -Gastroenterologic surgery -Thoracic surgery -Traumatic surgery -Orthopedic surgery -Pediatric surgery