Key result
Preoperative score predicts failure to achieve critical view of safety with ~0.73 AUROC.
Why the study?
A preoperative model to predict difficulty in achieving the critical view of safety during laparoscopic cholecystectomy was needed to guide surgical decision-making.
Can a preoperative imaging-based scoring system predict failure to achieve the critical view of safety during laparoscopic cholecystectomy?
Cohort
Can a preoperative imaging-based scoring system predict failure to achieve the critical view of safety during laparoscopic cholecystectomy?
A novel preoperative imaging-based scoring system demonstrated acceptable discrimination in predicting the difficulty of achieving the critical view of safety during laparoscopic cholecystectomy.
Background We developed and validated a preoperative model to predict the difficulty in achieving the critical view of safety (CVS) during laparoscopic cholecystectomy (LC). Methods Patients who underwent LC with preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography between January 2015 and December 2023 were retrospectively analyzed and randomly assigned to derivation and validation cohorts (8:2). Surgical difficulty was defined as failure to achieve CVS. Logistic regression analysis was used to identify independent predictors. Model performance was evaluated using the area under the receiver operating characteristic curve and Brier score. Results Independent preoperative risk factors included age ≥ 65 years, American Society of Anesthesiologists physical status ≥ 3, preoperative endoscopic gallbladder drainage or stenting, CT attenuation of the CVS window ≥ − 26 HU, and common bile duct disruption on magnetic resonance cholangiopancreatography (all *p* < 0.05). The prediction score (0–13) demonstrated an area under the receiver operating characteristic curve of 0.732 (95% confidence interval 0.528–0.936) in the validation cohort. Risk stratification identified low-, moderate-, and high-risk groups with increasing rates of failure to achieve CVS. Conclusions This preoperative imaging-based scoring system may help predict CVS failure in LC and guide surgical decision-making.
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Gunji et al. (2026) conducted a cohort in Laparoscopic cholecystectomy. Preoperative clinical and imaging-based prediction score was evaluated on Failure to achieve critical view of safety (CVS) model performance (AUROC) (AUROC 0.732, 95% CI 0.528-0.936). A preoperative scoring system incorporating clinical and imaging risk factors predicted failure to achieve the critical view of safety during laparoscopic cholecystectomy (AUROC 0.732; 95% CI 0.528-0.936).
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