title: Grading operative findings at laparoscopic cholecystectomy- a new scoring system.
abstract: BACKGROUND
  Variation in outcomes from surgery is a major challenge and defining surgical findings may help set benchmarks, which currently do not exist in laparoscopic cholecystectomy. This study outlines a new surgical scoring system incorporating key operative findings.
  
  
  METHODS
  English language studies (from January 1965 to July 2014) pertaining to severity scoring and predictors of difficult laparoscopic cholecystectomy were searched for in PubMed, Embase and Cochrane databases using the search terms 'Laparoscopic cholecystectomy or Lap chole' and/or 'Scoring Index or Grading system or Prediction of difficulty or Conversion to open' in various combinations. Cross-referencing from papers retrieved in the original search identified additional articles.
  
  
  RESULTS
  Sixteen published papers report a gallbladder (GB) scoring system, but all relate to pre-operative clinical and imaging findings, rather than operative findings. The current scoring system, using operative findings incorporates the appearance of the GB, presence of GB distension, ease of access, potential biliary complications and time taken to identify cystic duct and artery. A score of <2 would imply mild difficulty, 2-4 moderate, 5-7 severe and 8-10 extreme.
  
  
  CONCLUSIONS
  This paper reports one of the first operative classifications of findings at laparoscopic cholecystectomy. It has the potential to allow benchmarks for international collaboration of operative and patient outcomes in patients undergoing laparoscopic cholecystectomy.
authors: Department of Surgery, Letterkenny Hospital and Donegal Clinical Research Academy, National University Ireland Galway, Letterkenny, Donegal Ireland.
authors: Michael
authors: M
authors: Sugrue
authors: Department of Surgery, Letterkenny Hospital and Donegal Clinical Research Academy, National University Ireland Galway, Letterkenny, Donegal Ireland.
authors: Shaheel M
authors: SM
authors: Sahebally
authors: Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors: Luca
authors: L
authors: Ansaloni
authors: Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors: Martin D
authors: MD
authors: Zielinski
keywords: Cholecystectomy; Cholecystitis; Conversion to open; Laparoscopic; Operative severity scoring system