Indicators of surgical difficulty during laparoscopic cholecystectomy

Indicators of surgical difficulty during laparoscopic cholecystectomy

This survey will take 5 minutes of your time. Thank you for your valuable feedback and experience.
Name *

First NameLast Name
Age in years*
Gender*

MaleFemaleDo not wish to disclose
1. Place of work*

PrivateGovermentBoth Private and Government
2. How many cholecystectomies (both Laproscopic Cholecystectomies (LCs) and open cholecystectomies) have you performed as an operator or instructor? *

1-199200-499500-999>1000
3. How many LCs have you performed as an operator or instructor? *

1-199200-499500-999>1000
4. What is the maximum duration of surgery for LC that you or your institution would accept? *

less than 60 minless than 90 minless than 120 minless than 180 minless than 240 minNo limits (time does not matter)
5. What is the maximum estimated blood loss for LC that you or your institution would accept? *

less than 100 mlless than 200 mlless than 300 mlless than 400 mlless than 500 mlNo limits (the amount of blood loss does not matter)
6. How often do you perform intra-operative cholangiogram? *

AlwaysMajority of casesExceptional cases
7. In which of the clinical scenarios listed below, do you, as an operator or instructor, abandon conventional LC and convert to open cholecystectomy, laparoscopic partial cholecystectomy, etc.? Please check all that apply.*

Extensive operative timeExtensive blood lossDamage to adjacent organs or biliary tract injuryExtensive and dense adhesion to surrounding organs and/or greater omentumSevere fibrosis and scarring in Calot's triangle or gallbladder bed due to inflammation
8. When you encounter difficult LC cases, do you think open conversion would make the operation much easier? Please choose one of the following options. *

YesDepends on the caseNo, it will make it more difficultNo, it will be equally difficult
The following questions refer to potential factors contributing to surgical difficulty that can be identified at the time of operation.

1. Appearance of the gallbladder and its surroundings *

	Easy LC	Difficult LC	Cannot comment
Edematous change in the dissected area
Fibrotic adhesion of surrounding organs due to inflammation
Scarring adhesion of surrounding organs
Easy bleeding during adhesiolysis
Necrotic changes in the dissected area
Spontaneous (non-iatrogenic) perforation of the gallbladder wall and/or abscess formation towards the abdominal cavity noted during adhesiolysis
Cholecysto-enteric fistula
Excessive visceral fat
Inversion of the gallbladder in the gallbladder bed due to liver cirrhosis
Collateral vein formation due to liver cirrhosis

2. Appearance of the Calot's triangle*

	Easy LC	Difficult LC	Cannot comment
Edematous change in the Calot's triangle
Fibrotic change in the Calot's triangle
Scarring in the Calot's triangle
Easy bleeding during dissection of the Calot's triangle
Necrotic changes in the Calot's triangle
Impacted gallstone in the cystic duct
Anomalous cystic duct
Short cystic duct
Gallbladder neck mounting on the common bile duct

3. Appearance of the gallbladder bed*

	Easy LC	Difficult LC	Cannot comment
Edematous change in the gallbladder bed
Fibrotic change in the gallbladder bed
Scarring in the gallbladder bed
Easy bleeding during dissection of the gallbladder bed
Necrotic changes in the gallbladder bed
Abscess formation towards the liver parenchyma

4. Please fill in the blanks below if you think of any other factors that affect surgical difficulty of LC.

5. What is the utility of the below ultrasonographic findings for you to determine the type of cholecystectomy? *

	Useful Always	Useful Occasionally	Not required
Liver measurement
Liver echogenicity (Fatty liver)
Gall bladder measurement
Gall bladder wall thickness
Number of stones
Presence of impacted stones
CBD diameter
Pericholecystic fluid collection
Portal vein flow velocity

6. Please fill in the blanks below if you think other any other ultrasonographic finding will ease in anticipating complicated laproscopic cholecystectomy.
Should be Empty: