title: SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy.
abstract: BACKGROUND
  Although it has been 25 years since the introduction of laparoscopy to cholecystectomy, outcomes remain largely unchanged, with rates of bile duct injury higher in the modern age than in the era of open surgery. The SAGES Safe Cholecystectomy Task Force (SCTF) initiative seeks to encourage a culture of safety in laparoscopic cholecystectomy (LC) and reduce biliary injury. An expert consensus study was conducted to identify interventions thought to be most effective in pursuit of this goal.
  
  
  METHODS
  An initial list of items for safer practice in LC was identified by the SCTF through a nominal group technique (NGT) process. These were put forward to 407 SAGES committee members in two-stage electronically distributed Delphi surveys. Consensus was achieved if at least 80 % of respondents ranked an item as 4 or 5 on a Likert scale of importance (1-5). Additionally, respondents ranked five top areas of importance for the following domains: training, assessment, and research.
  
  
  RESULTS
  Thirty-nine initial items were identified through NGT. Response rates for each Delphi round were 40.2 and 34 %, respectively. Final consensus was achieved on 15 items, the majority of which related to non-technical factors in LC. Key domains for training, assessment, and research were identified. Critical view of safety was deemed most important for overall safety, as well as training and assessment of LC. Intraoperative cholangiography was identified as an additional priority area for future research.
  
  
  CONCLUSIONS
  Consensus items to progress surgical practice, training, assessment, and research have been identified, to promote safe practice and improve patient outcomes in LC.
authors: Department of Surgery and Cancer, Imperial College London, 10th floor QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK. p.pucher@imperial.ac.uk.
authors: Philip H
authors: PH
authors: Pucher
authors: Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
authors: L Michael
authors: LM
authors: Brunt
authors: Department of Surgery and Division of Gastroenterology, The Guthrie Clinic, Sayre, PA, USA.
authors: Robert D
authors: RD
authors: Fanelli
authors: Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
authors: Horacio J
authors: HJ
authors: Asbun
authors: Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada.|Faculty of Medicine, Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montreal, Canada.
authors: Rajesh
authors: R
authors: Aggarwal
mesh_terms: D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D003697:Delphi Technique; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D061214:Patient Safety
keywords: Cholecystectomy; Consensus; Expert; Patient safety