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

Yukio Iwashita; Taizo Hibi; Tetsuji Ohyama; Goro Honda; Masahiro Yoshida; Fumihiko Miura; Tadahiro Takada; Ho Seong Han; Tsann Long Hwang; Satoshi Shinya; Kenji Suzuki; Akiko Umezawa; Yoo Seok Yoon; In Seok Choi; Wayne Shih Wei Huang; Kuo Hsin Chen; Manabu Watanabe; Yuta Abe; Takeyuki Misawa; Yuichi Nagakawa; Dong Sup Yoon; Jin Young Jang; Hee Chul Yu; Keun Soo Ahn; Song Cheol Kim; In Sang Song; Ji Hoon Kim; Sung Su Yun; Seong Ho Choi; Yi Yin Jan; Yan Shen Shan; Chen Guo Ker; De Chuan Chan; Cheng Chung Wu; King Teh Lee; Naoyuki Toyota; Ryota Higuchi; Yoshiharu Nakamura; Yoshiaki Mizuguchi; Yutaka Takeda; Masahiro Ito; Shinji Norimizu; Shigetoshi Yamada; Naoki Matsumura; Junichi Shindoh; Hiroki Sunagawa; Takeshi Gocho; Hiroshi Hasegawa; Toshiki Rikiyama; Naohiro Sata; Nobuyasu Kano; Seigo Kitano; Hiromi Tokumura; Yuichi Yamashita; Goro Watanabe; Kunitoshi Nakagawa; Taizo Kimura; Tatsuo Yamakawa; Go Wakabayashi; Rintaro Mori; Itaru Endo; Masaru Miyazaki; Masakazu Yamamoto

doi:10.1002/jhbp.440

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

Yukio Iwashita, Taizo Hibi, Tetsuji Ohyama, Goro Honda, Masahiro Yoshida, Fumihiko Miura, Tadahiro Takada, Ho Seong Han, Tsann Long Hwang, Satoshi Shinya, Kenji Suzuki, Akiko Umezawa, Yoo Seok Yoon, In Seok Choi, Wayne Shih Wei Huang, Kuo Hsin Chen, Manabu Watanabe, Yuta Abe, Takeyuki Misawa, Yuichi NagakawaDong Sup Yoon, Jin Young Jang, Hee Chul Yu, Keun Soo Ahn, Song Cheol Kim, In Sang Song, Ji Hoon Kim, Sung Su Yun, Seong Ho Choi, Yi Yin Jan, Yan Shen Shan, Chen Guo Ker, De Chuan Chan, Cheng Chung Wu, King Teh Lee, Naoyuki Toyota, Ryota Higuchi, Yoshiharu Nakamura, Yoshiaki Mizuguchi, Yutaka Takeda, Masahiro Ito, Shinji Norimizu, Shigetoshi Yamada, Naoki Matsumura, Junichi Shindoh, Hiroki Sunagawa, Takeshi Gocho, Hiroshi Hasegawa, Toshiki Rikiyama, Naohiro Sata, Nobuyasu Kano, Seigo Kitano, Hiromi Tokumura, Yuichi Yamashita, Goro Watanabe, Kunitoshi Nakagawa, Taizo Kimura, Tatsuo Yamakawa, Go Wakabayashi, Rintaro Mori, Itaru Endo, Masaru Miyazaki, Masakazu Yamamoto

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Abstract

Background: We 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. Methods: Surgeons 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. Results: Response 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. Conclusions: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

Original language	English
Pages (from-to)	191-198
Number of pages	8
Journal	Journal of Hepato-Biliary-Pancreatic Sciences
Volume	24
Issue number	4
DOIs	https://doi.org/10.1002/jhbp.440
Publication status	Published - 01-04-2017

All Science Journal Classification (ASJC) codes

Surgery
Hepatology

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Iwashita, Y., Hibi, T., Ohyama, T., Honda, G., Yoshida, M., Miura, F., Takada, T., Han, H. S., Hwang, T. L., Shinya, S., Suzuki, K., Umezawa, A., Yoon, Y. S., Choi, I. S., Huang, W. S. W., Chen, K. H., Watanabe, M., Abe, Y., Misawa, T., ... Yamamoto, M. (2017). An opportunity in difficulty: Japan–Korea–Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy. Journal of Hepato-Biliary-Pancreatic Sciences, 24(4), 191-198. https://doi.org/10.1002/jhbp.440

@article{d06bd61878334ed4954d1246d54803ea,

title = "An opportunity in difficulty: Japan–Korea–Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy",

abstract = "Background: We 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. Methods: Surgeons 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. Results: Response 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. {\textquoteleft}Diffuse scarring in the Calot's triangle area{\textquoteright} in the {\textquoteleft}Factors related to inflammation of the gallbladder{\textquoteright} 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. Conclusions: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.",

keywords = "Acute cholecystitis, Delphi consensus, Laparoscopic cholecystectomy, Surgical difficulty",

author = "Yukio Iwashita and Taizo Hibi and Tetsuji Ohyama and Goro Honda and Masahiro Yoshida and Fumihiko Miura and Tadahiro Takada and Han, {Ho Seong} and Hwang, {Tsann Long} and Satoshi Shinya and Kenji Suzuki and Akiko Umezawa and Yoon, {Yoo Seok} and Choi, {In Seok} and Huang, {Wayne Shih Wei} and Chen, {Kuo Hsin} and Manabu Watanabe and Yuta Abe and Takeyuki Misawa and Yuichi Nagakawa and Yoon, {Dong Sup} and Jang, {Jin Young} and Yu, {Hee Chul} and Ahn, {Keun Soo} and Kim, {Song Cheol} and Song, {In Sang} and Kim, {Ji Hoon} and Yun, {Sung Su} and Choi, {Seong Ho} and Jan, {Yi Yin} and Shan, {Yan Shen} and Ker, {Chen Guo} and Chan, {De Chuan} and Wu, {Cheng Chung} and Lee, {King Teh} and Naoyuki Toyota and Ryota Higuchi and Yoshiharu Nakamura and Yoshiaki Mizuguchi and Yutaka Takeda and Masahiro Ito and Shinji Norimizu and Shigetoshi Yamada and Naoki Matsumura and Junichi Shindoh and Hiroki Sunagawa and Takeshi Gocho and Hiroshi Hasegawa and Toshiki Rikiyama and Naohiro Sata and Nobuyasu Kano and Seigo Kitano and Hiromi Tokumura and Yuichi Yamashita and Goro Watanabe and Kunitoshi Nakagawa and Taizo Kimura and Tatsuo Yamakawa and Go Wakabayashi and Rintaro Mori and Itaru Endo and Masaru Miyazaki and Masakazu Yamamoto",

note = "Publisher Copyright: {\textcopyright} 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery",

year = "2017",

month = apr,

day = "1",

doi = "10.1002/jhbp.440",

language = "English",

volume = "24",

pages = "191--198",

journal = "Journal of Hepato-Biliary-Pancreatic Sciences",

issn = "1868-6974",

publisher = "Wiley-Blackwell",

number = "4",

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Iwashita, Y, Hibi, T, Ohyama, T, Honda, G, Yoshida, M, Miura, F, Takada, T, Han, HS, Hwang, TL, Shinya, S, Suzuki, K, Umezawa, A, Yoon, YS, Choi, IS, Huang, WSW, Chen, KH, Watanabe, M, Abe, Y, Misawa, T, Nagakawa, Y, Yoon, DS, Jang, JY, Yu, HC, Ahn, KS, Kim, SC, Song, IS, Kim, JH, Yun, SS, Choi, SH, Jan, YY, Shan, YS, Ker, CG, Chan, DC, Wu, CC, Lee, KT, Toyota, N, Higuchi, R, Nakamura, Y, Mizuguchi, Y, Takeda, Y, Ito, M, Norimizu, S, Yamada, S, Matsumura, N, Shindoh, J, Sunagawa, H, Gocho, T, Hasegawa, H, Rikiyama, T, Sata, N, Kano, N, Kitano, S, Tokumura, H, Yamashita, Y, Watanabe, G, Nakagawa, K, Kimura, T, Yamakawa, T, Wakabayashi, G, Mori, R, Endo, I, Miyazaki, M & Yamamoto, M 2017, 'An opportunity in difficulty: Japan–Korea–Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 24, no. 4, pp. 191-198. https://doi.org/10.1002/jhbp.440

TY - JOUR

T1 - An opportunity in difficulty

T2 - Japan–Korea–Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

AU - Iwashita, Yukio

AU - Hibi, Taizo

AU - Ohyama, Tetsuji

AU - Honda, Goro

AU - Yoshida, Masahiro

AU - Miura, Fumihiko

AU - Takada, Tadahiro

AU - Han, Ho Seong

AU - Hwang, Tsann Long

AU - Shinya, Satoshi

AU - Suzuki, Kenji

AU - Umezawa, Akiko

AU - Yoon, Yoo Seok

AU - Choi, In Seok

AU - Huang, Wayne Shih Wei

AU - Chen, Kuo Hsin

AU - Watanabe, Manabu

AU - Abe, Yuta

AU - Misawa, Takeyuki

AU - Nagakawa, Yuichi

AU - Yoon, Dong Sup

AU - Jang, Jin Young

AU - Yu, Hee Chul

AU - Ahn, Keun Soo

AU - Kim, Song Cheol

AU - Song, In Sang

AU - Kim, Ji Hoon

AU - Yun, Sung Su

AU - Choi, Seong Ho

AU - Jan, Yi Yin

AU - Shan, Yan Shen

AU - Ker, Chen Guo

AU - Chan, De Chuan

AU - Wu, Cheng Chung

AU - Lee, King Teh

AU - Toyota, Naoyuki

AU - Higuchi, Ryota

AU - Nakamura, Yoshiharu

AU - Mizuguchi, Yoshiaki

AU - Takeda, Yutaka

AU - Ito, Masahiro

AU - Norimizu, Shinji

AU - Yamada, Shigetoshi

AU - Matsumura, Naoki

AU - Shindoh, Junichi

AU - Sunagawa, Hiroki

AU - Gocho, Takeshi

AU - Hasegawa, Hiroshi

AU - Rikiyama, Toshiki

AU - Sata, Naohiro

AU - Kano, Nobuyasu

AU - Kitano, Seigo

AU - Tokumura, Hiromi

AU - Yamashita, Yuichi

AU - Watanabe, Goro

AU - Nakagawa, Kunitoshi

AU - Kimura, Taizo

AU - Yamakawa, Tatsuo

AU - Wakabayashi, Go

AU - Mori, Rintaro

AU - Endo, Itaru

AU - Miyazaki, Masaru

AU - Yamamoto, Masakazu

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background: We 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. Methods: Surgeons 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. Results: Response 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. Conclusions: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

AB - Background: We 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. Methods: Surgeons 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. Results: Response 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. Conclusions: A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.

KW - Acute cholecystitis

KW - Delphi consensus

KW - Laparoscopic cholecystectomy

KW - Surgical difficulty

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UR - http://www.scopus.com/inward/citedby.url?scp=85016765975&partnerID=8YFLogxK

U2 - 10.1002/jhbp.440

DO - 10.1002/jhbp.440

M3 - Article

C2 - 28196311

AN - SCOPUS:85016765975

SN - 1868-6974

VL - 24

SP - 191

EP - 198

JO - Journal of Hepato-Biliary-Pancreatic Sciences

JF - Journal of Hepato-Biliary-Pancreatic Sciences

IS - 4

ER -

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

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