# Assessment of Structured Education on Young Surgeons’ Ability to Achieve a Quality Critical View of Safety During Laparoscopic Cholecystectomy: A Pre- and Post-intervention Longitudinal Study

## TL;DR

Teaching young surgeons how to properly use the critical view of safety during gallbladder surgery improves their technique and reduces injury risks.

## Contribution

Structured education significantly improves young surgeons' ability to achieve and report the critical view of safety during laparoscopic cholecystectomy.

## Key findings

- Educated surgeons achieved a significantly higher critical view of safety score compared to pre-education.
- Post-education, surgeons reported the critical view of safety correctly in all cases, unlike pre-education.
- No bile duct injuries occurred in the post-education group, though the difference was not statistically significant.

## Abstract

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for various gallbladder pathologies. However, bile duct injuries (BDIs) remain a major complication despite advancements in techniques. The critical view of safety (CVS) has been proposed to reduce BDI rates, yet, the “CVS Paradox” suggests that injury rates have remained stable in some centers despite reports of using the CVS technique.

Objective: This study aimed to assess the impact of structured educational sessions on young surgeons’ ability to achieve optimal CVS during LC.

Methods: A pre- and post-intervention longitudinal study was conducted on 40 patients, divided into two groups: Group A (pre-education) and Group B (post-education). Ten junior surgeons performed LCs at two centers, with each performing two procedures before and two after the educational intervention on CVS. Recorded surgical videos were assessed using a 6-point CVS scoring system.

Results: There were no statistically significant differences between the groups in terms of demographic data, preoperative diagnosis, or comorbidities. Intraoperative BDI occurred in 10% of Group A patients, but none in Group B (p=0.147). The CVS was misreported in 50% of Group A cases but in none of Group B (p<0.001). The mean CVS score was significantly higher in Group B (5.45±0.60) compared to Group A (3.80±0.82) (p=0.001). “Satisfactory CVS” achievement was also significantly greater in Group B (95%) versus Group A (40%) (p=0.001).

Conclusion: Structured educational sessions significantly improved the attainment of CVS and the accuracy of its reporting, suggesting that focused training can help reduce complications such as BDI during LC.