Live Quality Assurance: Using a Multimedia Messaging Service Group Chat to Instantly Grade Intraoperative Images.

Area of Science:

• Surgical technique assessment
• Medical imaging analysis
• Quality improvement in surgery

Background:

• The critical view of safety (CVS) is crucial for laparoscopic cholecystectomy (LC).
• Previous studies defined the technique for obtaining CVS photographic evidence.
• The practical consistency, accuracy, and feasibility of CVS in routine practice remain largely unknown.

Purpose of the Study:

• To determine the feasibility of timely feedback using an established image sharing and grading system for intraoperative CVS images.
• To evaluate if and how cholecystitis affects the ability to attain a CVS.

Main Methods:

• 193 laparoscopic cholecystectomies (LC) performed by 14 surgeons were analyzed.
• Intraoperative anterior and posterior CVS images were shared via multimedia messaging system (MMS).
• Images were remotely graded using a scoring system; response times and scores were recorded.

Main Results:

• Image scoring occurred in under 5 minutes with a mean of 3 peer responses, showing significant agreement.
• A small but significant difference in scoring agreement was noted between anterior and posterior images in acute cholecystitis cases.
• The CVS was almost always attainable.

Conclusions:

• An established image sharing and grading system enables real-time intraoperative feedback for CVS without compromising operative time or patient privacy.
• While CVS is generally attainable, acute cholecystitis is associated with decreased CVS quality and grading agreement.