Segment IV Approach is Useful for Whole-Layer Laparoscopic Cholecystectomy for Gallbladder Polyps

Background Whole-layer laparoscopic cholecystectomy (W-LC) has recently been advocated as a total biopsy for potentially malignant neoplasms of the gallbladder; however, it is not an injury-proof procedure. This study reports W-LC using the segment IV approach (technique for securing the whole-layer gallbladder at the medial origin of the cystic plate).MethodsTwenty among twenty-five patients diagnosed with potentially malignant gallbladder polyps underwent this technique.ResultsMostly, W-LC was performed successfully (median operative time 135 min) without intraoperative and postoperative complications. Pathological findings indicated that cholesteric polyps was the most common type (n=13), followed by adenomatous polyps (25%) and carcinoma in situ (5%).ConclusionsWe conclude that the segment IV approach is appropriate for performing total biopsy in patients diagnosed with potentially malignant gallbladder polyps.

Are YouTube Videos a Reliable Training Method for Safe Laparoscopic Cholecystectomy? A Simulated Decision-Making Exercise to Assess the Critical View of Safety

Background The present study assesses the educational value of laparoscopic cholecystectomy videos on YouTube regarding the correct application of the critical view of safety (CVS), and evaluates… surgical trainees' perceptions of the CVS criteria in a simulated, operative decision-making exercise. Methods YouTube was systematically searched for laparoscopic cholecystectomy videos, explicitly reporting a satisfactory CVS. The top 30 most popular videos, by number of views, were identified and scored on the 6-point scale by three experienced consultants. After watching a training module on CVS rationale and criteria, 10 trainees, blinded to the consultants' assessment, were instructed to view the videos, score each criterion and answer the binary question “Would you divide the cystic structures?” by “yes” or “no.” Results An inadequate CVS was found in 30% of the included videos. No statistical association was noted between number of views, likes, or dislikes with successful CVS rates. Inter-observer agreement between consultants and trainees ranged from minimal to moderate (k = 0.07–0.60). Discrepancy between trainees' CVS scores and their simulated decision to proceed to division of the cystic structures was found in 15% of assessments, with intra-observer agreement ranging from minimal to excellent (k = 0.27–1.0). For the CVS requirements, inter-observer agreement was minimal for the dissection of the cystic plate (k = 0.26) and triangle clearance (k = 0.39) and moderate for the identification of two and only two structures (k = 0.42). Conclusion The CVS is central to the culture of safety in laparoscopic cholecystectomy. Surgical videos are a useful training tool as simulated, operative decision-making exercises. However, public video platforms should be used judiciously, since their content is not peer-reviewed or quality-controlled.