Group chat allows instant grading of intraoperative cholecystectomy images

Last Updated: 2019-12-24

By Will Boggs MD

NEW YORK (Reuters Health) - A multimedia messaging service (MMS) group chat can be used real-time to grade images during laparoscopic cholecystectomy, researchers report.

"Imaging sharing and crowd-source grading has the potential to improve the quality of an operation or any medical service where imaging is possible," said Dr. Carl J. Westcott of Wake Forest School of Medicine, in Winston-Salem, and the W. G. Bill Hefner VA Medical Center, in Salisbury, North Carolina.

"Image grading through crowd sourcing also has the potential to teach surgical endpoints," he told Reuters Health by email.

The Society of American Gastrointestinal and Endoscopic Surgeons safe-cholecystectomy task force advocates liberal use of bile duct imaging to decrease the risk of bile duct injuries in laparoscopic cholecystectomy.

Consulting a peer surgeon is advised if the anatomy is unclear, but surgeons performing laparoscopic cholecystectomies do not always have the benefit of an available peer surgeon. Moreover, the idea of photodocumentation of the dissection is understudied and generally resisted.

Dr. Westcott's team captured images of the bile duct system using a cellphone camera and shared these images with an MMS group of 14 attending surgeons. They sought to establish proof of concept and to determine if pericystic inflammation affected image quality and/or grading agreement.

An average of three evaluations were received for all laparoscopic cholecystectomies performed during the study. The average response time from another surgeon was 3.7 minutes, and the average response time from a second surgeon was 10.7 minutes.

At 30-day follow-up, there were no bile leaks, bile duct injuries or bleeding, or return to the operating room for these patients, the authors report in the Journal of the American College of Surgeons.

Results were similar when only data for acute cholecystitis patients were included in the analysis.

Among the images scored by more than two raters, there was 85% agreement for anterior images and 82% agreement for posterior images. Pericystic inflammation decreased image quality and grading agreement, especially for the posterior view.

"Surgeons generally liked participating; it was more eagerly accepted than we expected, and now that the (quality assurance) project has ended, the chat group lives on," Dr. Westcott said. Also interesting "was the educational power. The exercise of submitting your own dissections and grading images of others standardized the surgeons in our group to a uniform interpretation of a surgical endpoint."

"This project only tested a concept," he said. "More specific software is needed. The common MMS system is not good enough for general use in this manner. The image acquisition protocols and grading scales need to be studied, perfected, and accepted prior to integration into common practice."

"Presently, we as medical providers and regulators are consumed with preoperative and post-operative quality metrics of a patient's surgery experience," Dr. Westcott added. "Yet, the outcome of that experience depends mostly on the quality of the operation itself. That said, no intraoperative quality metrics (with rare exceptions) are captured anywhere for any operation. This (elephant-in-the-room-like) omission has its reasons, but it is bound to change. This concept possibly represents the first building blocks in the progress to establishing procedural quality metrics."

SOURCE: https://bit.ly/35M7CMH Journal of the American College of Surgeons, online November 11, 2019.