title: Preoperative grading system for predicting operative conditions in laparoscopic cholecystectomy.
abstract: OBJECTIVE
  In a previous retrospective study, we predicted the operative conditions for abdominal wall-lifting laparoscopic cholecystectomy (ALLC), using a new preoperative grading system. We conducted the present study to evaluate the validity of our grading system prospectively, and to improve the operative outcome.
  
  
  METHODS
  Ninety-seven patients underwent cholecystectomy between January 2000 and March 2002, and were prospectively examined according to our preoperative grading system. Allotting 0-5 points for nine preoperative factors, the total combined score was defined as the predictive score. The postoperative score was defined by allotting 0-8 points to five operative factors. The ratio of the preoperative score / postoperative score was defined as the skill score.
  
  
  RESULTS
  The mean postoperative score was significantly correlated with the predictive score (P < 0.01). The mean operation time and the mean postoperative score differed significantly among surgeons with skill scores higher or less than 1.25 (P < 0.05). They were significantly improved (P < 0.05) by choosing an operator according to the predictive score and skill score.
  
  
  CONCLUSIONS
  Our preoperative grading system using the predictive score is a valid method of predicting the actual operative conditions of ALLC. An adequately skilled operator should be chosen according to the difficulty of each case, to ensure the best possible operative outcome.
authors.affiliation: Department of Surgery, Kikkoman General Hospital, Chiba, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Takegami
authors.forename: Yoneei
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kubota
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment