Audit of Laparoscopic Cholecystectomy: Impact of Procedure Recording on Clinical Practice.

Recorded videos of laparoscopic surgery can be used to audit surgical practice with a view to improve clinical practice and surgical outcomes. The objective was to audit our own practice by reviewing video recordings of laparoscopic cholecystectomies to improve our dissection in Calot's triangle and to prevent gall bladder perforation. We used recorded videos of laparoscopic cholecystectomy. In this study initially one hundred consecutive videos were reviewed for: a) establishment of critical view of safety, b) optimization of critical view of safety by division of cystic artery before cystic duct, c) perforation of gall bladder and d) use of diathermy for cystic artery. This prospective interventional audit was performed in a Civil Hospital, Karachi and Hamdard University Hospital, Karachi, Pakistan from January 2008 to March 2010. Recommendations were made according to published literature to change the practice in these steps of procedures. These recommendations were implemented in practice and the following 100 videos were reviewed for the same criteria to see the impact on clinical practice. In the first group, critical view of safety was established in 91 patients compared with 99 patients in 2nd group (p=0.009), optimization of view was done in 54 and 83 patients respectively (p<001), perforation occurred in 32 and 19 patients respectively (p=0.035) and use of diathermy for cystic artery, which was the routine, was stopped completely in the 2nd group. Audit of recorded videos of laparoscopic cholecystectomy can be used as an effective tool to improve surgical practice for safer and better outcome.