Inter-surgeon Variability in Cystic Artery Lymph Node Excision during Laparoscopic Cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Technique
• Biliary Surgery

Background:

• Expert opinion advises standardized laparoscopic cholecystectomy (LC) with dissection lateral to the cystic artery lymph node (LN) to reduce bile duct injury.
• Variability in surgical practice may lead to inconsistent patient outcomes.

Purpose of the Study:

• To assess the standardization of laparoscopic cholecystectomy (LC) by evaluating the variability in lymph node (LN) excision rates among surgeons.
• To determine if LN yield serves as a surrogate marker for surgical technique standardization.

Main Methods:

• Retrospective analysis of 2332 LCs performed by 27 surgeons at a single hospital.
• LN presence determined from histology reports; LN yield calculated per surgeon.
• Data analyzed for patient demographics, procedure type (elective/acute), and LN reporting rates.

Main Results:

• LN status was reported for 78.5% of specimens.
• Overall LN yield per surgeon varied widely, from 0% to 50%, with a mean of 18.7%.
• Significant inter-surgeon variability in LN excision rates was observed.

Conclusions:

• High variability in LN excision indicates differing surgical dissection techniques during LC.
• LN yield can serve as a measurable surrogate marker for assessing surgical technique standardization.
• Standardized surgical approaches are crucial for minimizing complications like bile duct injury.