Can Laparoscopic Cholecystectomy Difficulty Score Predict Difficult Surgery
Condition: Laparoscopic Cholecystectomy
Study type: Observational

Summary: 
      Laparoscopic cholecystectomy is the gold standard treatment method in symptomatic gallstone
      disease. However, complications that develop due to being a technical procedure tend to be
      more complex and more morbid-estimating how difficult the surgery will be before the
      operation will enable us to be more prepared both in terms of patient counseling and surgical
      team selection. Such a prediction will minimize the risk of complications and morbidity.

      In our study, investigators used the scoring system "How to predict difficult laparoscopic
      cholecystectomy? Proposal for a simple preoperative scoring system?" which was published in
      "The American Journal of Surgery" in November 2016. Investigators wanted to evaluate
      prospectively adequate "Laparoscopic Cholecystectomy Difficulty Score," which was developed
      retrospectively, in determining the surgical difficulty preoperatively.
    

Detailed description: 
      ETHICAL BOARD APPROVAL

      Konya Chamber of Commerce Education and Health Foundation was found ethically appropriate for
      the study according to the decision of Karatay University Ethical Board Presidency dated
      18.06.2019 and numbered 2019/0051.

      FEATURES OF THE STUDY AND SELECTION OF PATIENTS

      Patients who were to be operated due to symptomatic cholelithiasis between 01.03.2020 and
      31.07.2020 at the Health Sciences University (SBU) Konya Training and Research Hospital
      (KEAH) were included in the study. The study was done prospectively.

      Laparoscopic Cholecystectomy Difficulty Score (DSLC) developed in the reference study will be
      used. The sex of the patients and whether they had an attack of cholecystitis will be
      recorded. Neutrophil count, fibrinogen, and ALP levels will be recorded from preoperatively
      routine blood tests. DSLC score will be calculated before the patient goes into surgery. How
      successful the scoring system is in determining the difficulty of the operation in the
      postoperative period will be analyzed statistically.

      Thirteen surgeons will be included in the study. Based on the last ten surgery times, where
      each surgeon has no problems and has no technical difficulties, the average operation time
      will be calculated for each surgeon individually. In the reference study, it has been
      accepted that the surgeon's duration is more than 1.5 times or challenging to undergo open
      surgery. In our study, it will be considered as a difficult operation to exceed or exceed 1.5
      times the surgeon's duration. Other than that, it will be considered a smooth operation. The
      biliary tract injuries that occurred in exposed cases will be classified according to the
      Strasberg classification. In the reference study, statistically significant score groups were
      formed as low risk of 0 points, medium risk of 1-4 points, high risk of 5-9 points, and a
      very high risk of 10 points. In our study, these score groups will be created, and
      statistical analysis will be made. Also, ROC (Reciever Operator Characteristics Curve) curve
      will be created with the scores obtained from the scoring system, and the specificity and
      sensitivity of the scoring system will be statistically put.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population is comprised of patients between the ages of 18-100, who are referred
        to the general surgery clinic for laparoscopic cholecystectomy.