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New Proposed Classification of Difficulty in Laparoscopic Cholecystectomy
Assanee Tongyoo1, Aekkaphod Liwattanakun1, Ekkapak Sriussadaporn1
1Hepato-Pancreato-Biliary Surgery and Transplantation Unit, Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Luang, Thailand.
Summary
A new grading system for difficult laparoscopic cholecystectomy (LC) offers more flexibility. This surgeon-referenced classification adapts to individual operative findings, improving upon fixed-time criteria for assessing LC difficulty.
Area of Science:
- Surgical Innovation
- Laparoscopic Surgery
- Cholecystectomy Classification
Background:
- Difficult laparoscopic cholecystectomy (LC) presents ongoing surgical challenges.
- Existing grading systems, like Randhawa's, rely on fixed operative time, limiting universal applicability.
- A need exists for a more adaptable classification system for difficult LC.
Purpose of the Study:
- To propose and validate a new, more flexible classification system for difficult laparoscopic cholecystectomy.
- To develop a surgeon-referenced grading system incorporating individual factors beyond fixed operative times.
Main Methods:
- Retrospective cohort study of 523 patients undergoing LC for gallstone diseases (Jan 2017-Dec 2021).
- Exclusion of emergent cases, combined procedures, incomplete data, and conversions to open surgery.
- Patients initially classified using Randhawa's system, then reclassified using a new system based on mean and standard deviation of operative time.
Main Results:
- Randhawa classification: 39% easy, 53.7% difficult, 7.3% very difficult LC.
- New classification (mean and mean + 2SD dividers): 38.9% easy, 57.1% difficult, 4% very difficult LC.
- The new classification demonstrated greater flexibility and individual surgeon compatibility.
Conclusions:
- A novel surgeon-referenced grading system for difficult LC is proposed.
- This new classification is more flexible and adaptable than previous criterion-referenced systems.
- The system integrates surgeon-specific factors, enhancing its applicability.
