Simple classification system for predicting the difficulty level of laparoscopic cholecystectomy

Abstract

This cohort study examined the validity of our new classification system in predicting the difficulty level of laparoscopic cholecystectomy （LC）. We enrolled consecutive patients who underwent cholecystectomy at the Division of Gastroenterological and General Surgery in Showa University Hospital, Japan. Severe-grade LC was classified according to cholecystitis severity according to the 2013 Tokyo Guidelines, preoperative imaging findings, cystic duct depiction, and anatomical anomalies of the bile duct. Cases were categorized according to the degree of difficulty as follows: E （easy）, C （moderate）, and D （difficult）. Moreover, preoperative prediction accuracy was evaluated by determining the degree of inflammation and presence of anatomical variation based on operative data. Operative variables and morbidity were retrospectively evaluated. LC was performed in 534 patients, 424 of whom were assessed. The accuracy of the correlation between the classification system and intraoperative findings was as follows: E, 77%, C, 61%, and D, 76%. The average operative time was 109±44, 134±43, and 172±58 min for E, C, and D levels, respectively （P＝0.0022; E/C, P＜0.0001; C/D, P＜0.0001; E/D, P＝0.00017）. The average blood loss was 17±31, 43±61, and 71±53ml for E, C, and D levels, respectively （P＝0.0020; E/C, P＜0.0001; C/D, P＝0.0201; E/D, P＜0.0001）. The surgical outcomes significantly differed between the levels; however, the conversion and morbidity rates did not. In conclusion, our classification system was correlated with intraoperative findings and surgical outcomes, thereby contributing to improved LC outcomes.