TPT 7.19 Automated Analysis of Intraoperative Phase in Laparoscopic Cholecystectomy: A Comparison of One Consultant Surgeon and their Trainees

Abstract Background This study compares the intraoperative phase times in laparoscopic cholecystectomy performed by a consultant surgeon and supervised trainees over 10-years to assess operative times as a marker of performance and any impact of case severity on times. Methods Laparoscopic cholecystectomy videos were uploaded to Touch Surgery™ Enterprise, a combined software and hardware solution for securely recording, storing, and analysing surgical videos, which provide analytics of intraoperative phase times. Case severity and visualisation of the critical view of safety (CVS) were manually assessed using modified 10-point intraoperative gallbladder scoring system (mG10) and CVS scores, respectively. Consultant and trainees’ times were compared unmatched and matched by mG10. Results 159 (consultant=96, trainee=63) laparoscopic cholecystectomy videos and intraoperative phase times were reviewed on Touch Surgery™ Enterprise and analysed. Consultant cases were more challenging (p=0.037). Trainees’ achieved higher CVS scores (p=0.034) and showed longer dissection of hepatocystic triangle (HCT) times (p=0.012) in more challenging cases. Trainees’ total operative time (p=0.001) and dissection of HCT (p=0.002) times exceeded the consultant’s in low-severity matched cases (mG10=1). Trainees’ total operative times (p<0.001), port insertion/gallbladder exposure (p=0.032), and dissection of HCT (p<0.001) exceeded the consultant’s in matched cases (mG10=2). Trainees’ total operative (p<0.001), dissection of HCT (p<0.001), and gallbladder dissection (p=0.010) times exceeded the consultants in unmatched cases. Conclusion Trainees’ total operative and dissection of HCT times significantly exceeded the consultant’s unmatched cases and low-severity matched cases which could suggest training need, however, also reflects an expected assessment of competence, and validates time as a marker of performance.