Using video analytics to standardise complexity of Gallbladder surgery

Abstract Background: Cholecystitis is a widespread disease with an associated spectrum of complications; hence, laparoscopic cholecystectomies are commonly performed. Current grading scales are quantitative and objective. There is a need for a dynamic scoring tool that can help standardise training, theatre scheduling, and utilisation and could be incorporated into artificial intelligence. Aim/Hypothesis: • To develop and validate a dynamic scoring tool that incorporates the procedure's difficulty and severity of cholecystitis in correlation to operation time. • We hypothesise that a higher score correlates positively with increasing time, which could dynamically enhance operating room efficiency and turnover. Material & Method: A retrospective review of n = 123 LC videos of anonymised patients of Royal Cornwall Hospital NHS Trust, Treliske, the UK, between April 2019 - September 2021 was performed. A scoring system was proposed to analyse the correlation between cholecystitis severity, the difficulty of the operation and operative time. The tool comprised variables such as gall bladder characteristics, operative steps, anomalies, and additional procedures. Results: During the study period, n = 123 cholecystectomy procedures were analysed, n = 81 (65.85%) met the inclusion criteria and n=42 (34.15%) were excluded. The average total score per video was 8.63, with an average completion time of approx. 65 minutes. The results confirmed a positive correlation of R= 0.791 between higher scores leading to extended operative time. Further analysis showed a positive correlation of R= 0.607 was achieved between the Initial Assessment Score and the Initial Assessment Time to assess the gall bladder characteristics. Additionally, a strong positive correlation of R= 0.944 was attained for Total Score, Completion Time, and Initial Assessment Score. Conclusion: The proposed grading scale is a practical predictor of the complexity of the procedure in correlation with the duration of the operation. The grading scale should be helpful in surgical training and improved theatre scheduling and utilisation.