The “right” way is not always popular: comparison of surgeons’ perceptions during laparoscopic cholecystectomy for acute cholecystitis among experts from Japan, Korea and Taiwan

Taizo Hibi, Yukio Iwashita, Tetsuji Ohyama, Goro Honda, Masahiro Yoshida, Tadahiro Takada, Ho Seong Han, Tsann Long Hwang, Satoshi Shinya, Kenji Suzuki, Akiko Umezawa, Yoo Seok Yoon, In Seok Choi, Wayne Shih Wei Huang, Kuo Hsin Chen, Fumihiko Miura, Manabu Watanabe, Yuta Abe, Takeyuki Misawa, Yuichi NagakawaDong Sup Yoon, Jin Young Jang, Hee Chul Yu, Keun Soo Ahn, Song Cheol Kim, In Sang Song, Ji Hoon Kim, Sung Su Yun, Seong Ho Choi, Yi Yin Jan, Shyr Ming Sheen-Chen, Yan Shen Shan, Chen Guo Ker, De Chuan Chan, Cheng Chung Wu, Naoyuki Toyota, Ryota Higuchi, Yoshiharu Nakamura, Yoshiaki Mizuguchi, Yutaka Takeda, Masahiro Ito, Shinji Norimizu, Shigetoshi Yamada, Naoki Matsumura, Junichi Shindoh, Hiroki Sunagawa, Takeshi Gocho, Hiroshi Hasegawa, Toshiki Rikiyama, Naohiro Sata, Nobuyasu Kano, Seigo Kitano, Hiromi Tokumura, Yuichi Yamashita, Goro Watanabe, Kunitoshi Nakagawa, Taizo Kimura, Tatsuo Yamakawa, Go Wakabayashi, Itaru Endo, Masaru Miyazaki, Masakazu Yamamoto

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Background: Generally, surgeons’ perceptions of surgical safety are based on experience and institutional policy. Our recent pilot survey demonstrated that the acceptable duration of surgery and criteria for open conversion during laparoscopic cholecystectomy (LC) vary among workplaces. Methods: A web-based survey was distributed to 554 expert LC surgeons in Japan, Korea, and Taiwan. The questionnaire covered LC experience, safety measures and recognition of landmarks, decision-making regarding conversion to open/partial cholecystectomy and the implications of this decision. Overall responses were compared among nations, and then stratified by LC experience level (lifetime cases 200–499, 500–999, and ≥1,000). Results: The response rate was 92.6% (513/554); 67 surgeons with ≤199 LCs were excluded, and responses from 446 surgeons were analyzed. We observed significant differences among nations on almost all questions. Differences that remained after stratification by LC experience were on questions related to acceptable duration of surgery, adoption rates of intraoperative cholangiography, the “critical view of safety” technique, identification of Rouvière's sulcus, recognition of the SS-Inner layer theory, and intraoperative judgment to abandon conventional LC. Conclusions: Even among experts, surgeons’ perceptions during LC are workplace-dependent. A novel grading system of surgical difficulty and standardized LC procedures are paramount to generate high-level evidence.

Original languageEnglish
Pages (from-to)24-32
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number1
Publication statusPublished - 2017 Jan 1


  • Acute cholecystitis
  • Critical view of safety
  • Laparoscopic cholecystectomy
  • SS-Inner theory
  • Surgical difficulty

ASJC Scopus subject areas

  • Surgery
  • Hepatology


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