Intraoperative Cholangiogram Interpretation for Laparoscopic Transcystic Bile Duct Exploration: Is Concurrence...

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Diagnostic Imaging in Surgery

Background:

• Laparoscopic transcystic bile duct exploration (LTCBDE) is a safe and effective method for treating common bile duct (CBD) stones.
• The decision to perform LTCBDE relies on intraoperative cholangiogram (IOC) interpretation, which is subjective and lacks standardized criteria.
• Operator dependency and poor interpretation of IOCs can affect the success of LTCBDE.

Purpose of the Study:

• To assess the level of agreement among experienced surgeons regarding the interpretation of IOCs for LTCBDE.
• To identify critical IOC features influencing the complexity of common bile duct stone extraction.
• To evaluate surgeon consensus on the suitability of LTCBDE based solely on IOC imaging.

Main Methods:

• Retrospective review of IOC images from 40 patients who underwent laparoscopic cholecystectomy (LC) and LTCBDE.
• Independent review of IOC images by hepato-pancreato-biliary (HPB) and acute care surgery (ACS) specialists.
• Assessment of agreement percentages and Kappa statistics for IOC features and LTCBDE suitability.

Main Results:

• Overall agreement on IOC features ranged from 52.5% to 82.5%, with >75% considered robust.
• High agreement was observed in interpreting cystic duct morphology (straight vs. spiral valves).
• Substantial agreement was found on the suitability of LTCBDE (ACS: 92.5%, HPB: 95%, total: 87.5%), with high intra-specialty concordance.

Conclusions:

• Anatomical features on IOCs showed higher inter-rater agreement than measurements.
• The study highlights a need for a structured approach to IOC interpretation in LTCBDE.
• Developing standardized criteria can enhance surgical education and decision-making for LTCBDE.