Development and Validation of a Novel Intraoperative Scoring Tool Using Video Analytics to Standardise the Complexity of Gallbladder Surgery

Author(s): H Naseem, A Tam, H Naseem, M Hutton, M Clarke, I Finlay, J Clark

Background: Cholecystitis is a common disease that is often treated with laparoscopic cholecystectomies. Existing grading scales lack dynamism. Introducing a dynamic intraoperative scoring tool would help standardize training, utilisation and scheduling of operating rooms,that later 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.

Method: A retrospective review of n = 123 LC videos of anonymised patients of Royal Cornwall Trust Hospital, the UK, between April 2019 - September 2021 was performed. It was to propose a scoring tool that analysed the correlation between cholecystitis severity, the difficulty of the operation and operative time. The system considers gall bladder characteristics, operative steps, anomalies, and additional procedures.

Results: In the study, 123 cholecystectomy procedures were analysed, n = 81(65.85%) met inclusion criteria and n=42 (34.15%) were excluded. The average total score per video was 8.63, and the completion time was around 65 minutes. Higher scores correlated positively with extended operative time (R=0.791). The initial Assessment Score positively correlated with the Initial Assessment Time (R=0.607). Total Score, Completion Time, and Initial Assessment Score had a strong positive correlation (R=0.944).

Conclusion: The proposed grading scale is a practical predictor of the complexity and the duration of the operation. As envisaged it should be helpful in surgical training and enhance theatre efficiency.