@article{a19e517230c54f70afd8dc3ca81a7246,
title = "The “right” way is not always popular: comparison of surgeons{\textquoteright} perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan",
abstract = "Background: Generally, surgeons{\textquoteright} perceptions of surgical safety are based on experience and institutional policy. Our recent pilot survey demonstrated that the acceptable duration of surgery and criteria for open conversion during laparoscopic cholecystectomy (LC) vary among workplaces. Methods: A web-based survey was distributed to 554 expert LC surgeons in Japan, Korea, and Taiwan. The questionnaire covered LC experience, safety measures and recognition of landmarks, decision-making regarding conversion to open/partial cholecystectomy and the implications of this decision. Overall responses were compared among nations, and then stratified by LC experience level (lifetime cases 200–499, 500–999, and ≥1,000). Results: The response rate was 92.6% (513/554); 67 surgeons with ≤199 LCs were excluded, and responses from 446 surgeons were analyzed. We observed significant differences among nations on almost all questions. Differences that remained after stratification by LC experience were on questions related to acceptable duration of surgery, adoption rates of intraoperative cholangiography, the “critical view of safety” technique, identification of Rouvi{\`e}re's sulcus, recognition of the SS-Inner layer theory, and intraoperative judgment to abandon conventional LC. Conclusions: Even among experts, surgeons{\textquoteright} perceptions during LC are workplace-dependent. A novel grading system of surgical difficulty and standardized LC procedures are paramount to generate high-level evidence.",
keywords = "Acute cholecystitis, Critical view of safety, Laparoscopic cholecystectomy, SS-Inner theory, Surgical difficulty",
author = "Taizo Hibi and Yukio Iwashita and Tetsuji Ohyama and Goro Honda and Masahiro Yoshida 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 Fumihiko Miura 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 Sheen-Chen, {Shyr Ming} and Shan, {Yan Shen} and Ker, {Chen Guo} and Chan, {De Chuan} and Wu, {Cheng Chung} 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 Itaru Endo and Masaru Miyazaki and Masakazu Yamamoto",
note = "Funding Information: This survey was conducted as part of a Japan?Korea?Taiwan Collaborative Project: Defining the surgical difficulty during laparoscopic cholecystectomy based solely on intraoperative findings. We express our sincere gratitude to all respondents of this study for their active participation (information about the respondents is shown in Fig.?S2); and Rintaro Mori, MD, PhD, MSc, FRCPCH (Director, Department of Health Policy and Department of Clinical Epidemiology, National Center for Child Health and Development, Tokyo, Japan; Director, Cochrane Japan), Masafumi Inomata, MD, PhD (Professor, Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan), and Steven M. Strasberg, MD, FACS (Pruett Professor of Surgery, Division of General Surgery, Hepatobiliary-Pancreatic and Gastrointestinal Surgery Section, Washington University School of Medicine in St. Louis, Missouri, USA) for their professional guidance. The content of this article was presented to some extent at the following meetings: The 42nd Congress of the Korean Association of Hepato-Biliary-Pancreatic Surgery (Gyeongju, Korea; April 24, 2015), the 27th Meeting of Japanese Society of Hepato-Biliary-Pancreatic Surgery (Tokyo, Japan; June 12, 2015), Symposium: ?Defining the Surgical Difficulties of Laparoscopic Cholecystectomy Based Solely on Intraoperative Findings? hosted by the Taiwan Surgical Society of Gastroenterology (Taipei, Taiwan; July 11, 2015), and the 28th Meeting of Japanese Society of Hepato-Biliary-Pancreatic Surgery (Osaka, Japan; June 2, 2016). Publisher Copyright: {\textcopyright} 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery",
year = "2017",
month = jan,
day = "1",
doi = "10.1002/jhbp.417",
language = "English",
volume = "24",
pages = "24--32",
journal = "Journal of Hepato-Biliary-Pancreatic Sciences",
issn = "1868-6974",
publisher = "Springer Verlag",
number = "1",
}