Project interpret cholangiogram at the SAGES 2024 Education & Innovation Center: skill deficiency in bile duct injury...

Bile duct injuries (BDI) remain a rare but dreaded complication of laparoscopic cholecystectomy (LC). Proposed solutions to reduce BDI involve increased use of cholangiograms in patients with ambiguous anatomy. One explanation for the underutilization of intraoperative cholangiograms (IOC) is an unfamiliarity in interpreting cholangiograms, particularly amongst surgical trainees. We aim to gauge the current confidence levels and knowledge state of interpreting cholangiograms of surgeons at all levels of training.

Participants were screened based on their SAGES 2024 Annual Conference attendance and completed the "Cholangiogram Quiz" at a station in the SAGES Education & Innovation Center. Data were collected on training background, and confidence in identifying IOC findings. Participants (n = 88, surgical residents, fellows and attendings) completed eighteen multiple choice questions on interpreting a cholangiogram.

Overall quiz scores and confidence in interpreting IOC increased with level of training (p < 0.001). Out of normal IOC, aberrant ducts, BDI, common bile duct calculi, and filling defects, PGY1-5 residents were least confident identifying aberrant ducts, followed by BDI. PGY1-3 residents performed worse than attendings on questions on BDI (p < 0.001). Differences in quiz performance by training levels did not reach statistical significance for any other topic tested. Better quiz performance was directly correlated to more frequent use of IOC (p < 0.001). Higher confidence was associated with better quiz performance for all participants (p = 0.006). Confidence interpreting normal IOC and BDI on cholangiogram were directly correlated to quiz performance on these topics (normal IOC: p = 0.005, BDI: p = 0.047).

Participants with more advanced training, and who more frequently utilize IOC performed better on our quiz. Compared to other findings seen on IOC, residents failed to identify BDI. Surgical residents would benefit from targeted educational interventions to bolster confidence and improve accuracy in identifying BDI on IOC.