title: Improving Critical View of Safety in Laparoscopic Cholecystectomy by Teaching Interventions.
abstract: BACKGROUND
  Guidelines recommend obtaining a critical view of safety (CVS) during laparoscopic cholecystectomies to prevent serious bile duct injuries. We sought to evaluate the results of a teaching intervention for surgeons and residents about achieving CVS.
  
  
  METHODS
  The intervention consisted of a lecture followed by a handout on CVS along with a teaching video on how to perform a laparoscopic cholecystectomy and common pitfalls encountered. After 9 months, the whole intervention was repeated. We retrospectively collected demographic data, details about the procedure, and complications for 316 consecutive patients who underwent laparoscopic cholecystectomy and reviewed available videos of laparoscopic cholecystectomy for 229 of these patients. Videos before and after the teaching interventions were reviewed by 2 gastrointestinal surgeons regarding whether CVS was reached, and Kappa statistics were calculated to measure inter-rater agreement.
  
  
  RESULTS
  Most patients (average age 51 years) underwent laparoscopic cholecystectomy for symptomatic cholelithiasis (n = 171, 75%). CVS was reached in 69% of the preteaching intervention patients (n = 54), in 73% after the first teaching intervention (n = 75) and in 82% after the second intervention (n = 100) (not significant, overall p = 0.070). The complication rates were 24% (n = 13) before the intervention, 19% (n = 14) after the first teaching intervention, and 17% (n = 17) after the second intervention (not significant). In these groups, 1, 3, and 5 cases, correspondingly, with biliary injury were identified. All but 1 complication was related to a type A biliary injury.
  
  
  CONCLUSIONS
  After the teaching interventions, the complication rate and the rate of reaching CVS did not improve significantly. To improve surgeons' success in reaching CVS, more personal interventions may be more effective than the group intervention we used in this study. The next step may be to present surgeons and residents who have a low CVS rate directly with their personal results.
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands. Electronic address: mnijssen@amphia.nl.
authors: Marissa A J
authors: MA
authors: Nijssen
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors: Jennifer M J
authors: JM
authors: Schreinemakers
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors: George P
authors: GP
authors: van der Schelling
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors: Rogier M P H
authors: RM
authors: Crolla
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors: Arjen M
authors: AM
authors: Rijken
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002769:Cholelithiasis / Q000601:surgery*; D002983:Clinical Competence; D004501:Education, Medical; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D014741:Video Recording
keywords: CVS; Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; cholesystectomy; laparoscopic; teaching intervention