An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

被引：49

作者：

Iwashita, Yukio ^{[1
]}

Hibi, Taizo ^{[2
]}

Ohyama, Tetsuji ^{[3
]}

Honda, Goro ^{[4
]}

Yoshida, Masahiro ^{[5
]}

Miura, Fumihiko ^{[6
]}

Takada, Tadahiro ^{[6
]}

Han, Ho-Seong ^{[7
]}

Hwang, Tsann-Long ^{[8
]}

Shinya, Satoshi ^{[9
]}

Suzuki, Kenji ^{[10
]}

Umezawa, Akiko ^{[11
]}

Yoon, Yoo-Seok ^{[7
]}

Choi, In-Seok ^{[12
]}

Huang, Wayne Shih-Wei ^{[13
]}

Chen, Kuo-Hsin ^{[14
,15
,16
]}

Watanabe, Manabu ^{[17
]}

Abe, Yuta ^{[2
]}

Misawa, Takeyuki ^{[18
]}

Nagakawa, Yuichi ^{[19
]}

Yoon, Dong-Sup ^{[20
]}

Jang, Jin-Young ^{[21
]}

Yu, Hee Chul ^{[22
]}

Ahn, Keun Soo ^{[23
]}

Kim, Song Cheol ^{[24
,25
]}

Song, In Sang ^{[26
]}

Kim, Ji Hoon ^{[27
]}

Yun, Sung Su ^{[28
]}

Choi, Seong Ho ^{[29
]}

Jan, Yi-Yin ^{[8
]}

Shan, Yan-Shen ^{[30
]}

Ker, Chen-Guo ^{[31
]}

Chan, De-Chuan ^{[32
]}

Wu, Cheng-Chung ^{[33
]}

Lee, King-Teh ^{[34
]}

Toyota, Naoyuki ^{[35
]}

Higuchi, Ryota ^{[36
]}

Nakamura, Yoshiharu ^{[37
]}

Mizuguchi, Yoshiaki ^{[38
]}

Takeda, Yutaka ^{[39
]}

Ito, Masahiro ^{[40
]}

Norimizu, Shinji ^{[41
]}

Yamada, Shigetoshi ^{[42
]}

Matsumura, Naoki ^{[43
]}

Shindoh, Junichi ^{[44
]}

Sunagawa, Hiroki ^{[45
]}

Gocho, Takeshi ^{[46
]}

Hasegawa, Hiroshi ^{[47
]}

Rikiyama, Toshiki ^{[48
]}

Sata, Naohiro ^{[49
]}

机构：

[1] Oita Univ, Fac Med, Dept Gastroenterol & Pediat Surg, Oita, Japan

[2] Keio Univ, Dept Surg, Sch Med, Tokyo, Japan

[3] Oita Univ, Dept Clin Stat & Data Management, Fac Med, Oita, Japan

[4] Tokyo Metropolitan Komagome Hosp, Dept Surg, Tokyo, Japan

[5] Int Univ Hlth & Welf, Chemotherapy Res Inst, Dept Hemodialysis & Surg, Chiba, Japan

[6] Teikyo Univ, Dept Surg, Sch Med, Tokyo, Japan

[7] Seoul Natl Univ, Dept Surg, Bundang Hosp, Seongnam Si, South Korea

[8] Lin Kou Chang Gung Mem Hosp, Div Gen Surg, Tayuan, Taiwan

[9] Fukuoka Kieikai Hosp, Dept Surg, Fukuoka, Japan

[10] Fujinomiya City Gen Hosp, Dept Surg, Shizuoka, Japan

[11] Minimally Invas Surg Ctr, Yotsuya Med Cube, Tokyo, Japan

[12] Konyang Univ Hosp, Dept Surg, Daejeon, South Korea

[13] Show Chwan Mem Hosp, Dept Surg, Changhua, Taiwan

[14] Far Eastern Mem Hosp, Dept Surg, New Taipei, Tauyuan, Taiwan

[15] Far Eastern Mem Hosp, Dept Elect Engn, New Taipei, Tauyuan, Taiwan

[16] Yuan Ze Univ, New Taipei, Tauyuan, Taiwan

[17] Toho Univ, Dept Surg, Ohashi Med Ctr, Tokyo, Japan

[18] Jikei Univ, Dept Surg, Kashiwa Hosp, Chiba, Japan

[19] Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan

[20] Yonsei Univ, Dept Surg, Gangnam Severance Hosp, Seoul, South Korea

[21] Seoul Natl Univ Hosp, Dept Surg, Seoul, South Korea

[22] Chonbuk Natl Univ Hosp, Dept Surg, Jeonju, South Korea

[23] Keimyung Univ, Dept Surg, Dongsan Med Ctr, Daegu, South Korea

[24] Univ Ulsan, Dept Surg, Coll Med, Seoul, South Korea

[25] Asan Med Ctr, Seoul, South Korea

[26] Chungnam Natl Univ Hosp, Dept Surg, Daejeon, South Korea

[27] Eulji Univ Hosp, Dept Surg, Daejeon, South Korea

[28] Yeungnam Univ, Dept Surg, Daegu, South Korea

[29] Sungkyunkwan Univ, Dept Surg, Seoul, South Korea

[30] Natl Cheng Kung Univ Hosp, Dept Surg, Tainan, Taiwan

[31] Yuans Gen Hosp, Dept Surg, Kaohsiung, Taiwan

[32] Triserv Gen Hosp, Div Gen Surg, Natl Def Med Ctr, Taipei, Taiwan

[33] Taichung Vet Gen Hosp, Dept Surg, Taichung, Taiwan

[34] Kaohsiung Med Univ Hosp, Dept Surg, Kaohsiung, Taiwan

[35] Musashino Tokushukai Hosp, Dept Surg, Tokyo, Japan

[36] Tokyo Womens Med Univ, Inst Gastroenterol, Dept Surg, Tokyo, Japan

[37] Nippon Med Sch, Dept Gastrointestinal & Hepatobiliarypancreat Sur, Tokyo, Japan

[38] Nippon Med Sch, Dept Surg, Tokyo, Japan

[39] Kansai Rosai Hosp, Dept Surg, Amagasaki, Hyogo, Japan

[40] Fujita Hlth Univ, Dept Gen & Pancreat Surg, Qual & Safety Healthcare, Toyoake, Aichi, Japan

[41] Nagoya Daini Red Cross Hosp, Dept Surg, Nagoya, Aichi, Japan

[42] Kameda Med Ctr, Dept Surg, Chiba, Japan

[43] Tohoku Rosai Hosp, Dept Surg, Sendai, Miyagi, Japan

[44] Toranomon Gen Hosp, Dept Digest Surg, Tokyo, Japan

[45] St Lukes Int Hosp, Dept Surg Gastroenterol, Tokyo, Japan

[46] Jikei Univ, Dept Surg, Sch Med, Tokyo, Japan

[47] Tokai Hosp, Laparoscop Surg Ctr, Nagoya, Aichi, Japan

[48] Jichi Med Univ, Saitama Med Ctr, Dept Surg, Saitama, Japan

[49] Jichi Med Univ, Dept Surg, Shimotsuke, Tochigi, Japan

[50] Chiba Tokushukai Hosp, Director, Chiba, Japan

来源：

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES | 2017年 / 24卷 / 04期

关键词：

Acute cholecystitis; Delphi consensus; Laparoscopic cholecystectomy; Surgical difficulty; PREDICT TECHNICAL DIFFICULTIES; ACUTE CHOLECYSTITIS; RISK-FACTORS; CONVERSION; GALLBLADDER; CHOLECYSTOSTOMY; SYSTEM; SCORE;

D O I：

10.1002/jhbp.440

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BackgroundWe previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty. MethodsSurgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses 2 and (2) 66% of the responses concentrated within a median 1 after stratification by workplace and LC experience level. ResultsResponse rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. Diffuse scarring in the Calot's triangle area' in the Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score. ConclusionsA Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

引用

页码：191 / 198

页数：8

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