Scoring System of Eubanks et al for Laparoscopic Cholecystectomy

Description

Eubanks et al developed a scoring system for evaluating the performance of a laparoscopic cholecystectomy procedure. This can help to identify areas for improvement in the operative technique. The authors are from multiple US institutions with the first author from the University of Washington in Seattle.

Parts of the score:

(1) scoring of the different steps taken during the procedure

(2) scoring of errors during the procedure

Step	Action	Points if Performed
initial exposure	placement of fundus grasper	2
	placement of body grasper	3
	retraction of fundus cephalad	2
	retraction of body anterolateral	3
initial dissection	start dissection at body infundibular junction	5
	identification of cystic duct	5
	circumferential dissection of duct	5
cystic duct dissection	adequate length of duct (enough for clips and catheter)	8
	proximal clip	2
	distal clip or ligature placement	2
	division of duct	5
cystic duct cannulation	ductotomy	8
	catheter placement	8
	secure catheter	2
	remove catheter	2
cystic artery dissection	identify cystic artery	5
	circumferential dissection	5
	adequate length (enough for clips and transection)	5
	proximal clip	2
	distal clip	2
	transection of artery	5
gallbladder fossa dissection	areolar tissue division	10
	inspect liver bed	4

where:

• The cystic duct cannulation steps are skipped if a cholangiogram is not performed.

raw procedural score =

= SUM(points for cholecystectomy procedural actions)

Site	Error	Points per Occurrence
gallbladder	gallbladder injury, mechanical or cautery, with no bile spilled	1
	unintentional release of the gallbladder with grasper	1
	gallbladder injury with bile and/or stones spilled	10
liver	liver injury (including cautery) without bleeding	1
	liver injury with bleeding	5
	major vascular injury (other than cystic artery)	50
	common bile duct and/or hepatic duct injury	100
cystic duct	additional attempt at clip/ligature placement on duct	1
	additional attempt at ductotomy	1
	additional attempt at cystic duct cannulation	1
	misplaced clip or ligature on cystic duct	2
	unintentional removal of cholangiogram catheter	5
	unintentional cystic duct transection	10
	failure to cannulate patent cystic duct (mark only once)	10
cystic artery	additional attempt to clip placement on artery	1
	additional attempt at cutting cystic artery	1
	misplaced clip on cystic artery (clip on clip, partial occlusion, and so forth)	2
	mistaking artery for duct	5
	mistaking duct for artery	5
	cystic artery tear	15
miscellaneous	injury to other abdominal viscera	25
	prolonged operative time (> 90 minutes, excluding cholangiogram)	10 per 15 minutes

operative time =

= (total time of procedure) – (cholangiogram time if done)

where:

• If operative time <= 90, then error points is 0.

• If operative time > 90, then error points = (((operative time) – 90) / 15) * 10.

• The error points can be used raw, rounded, or as the INT(value). I used the rounded value in the implementation.

error subscore =

= (points for each error type) * (number of times event occurred)

error score =

= SUM(error subscores)

final score in percent =

= ((raw procedural score) – (error score)) / (maximum procedural score) * 100%

Interpretation:

• minimum raw procedural score: 0

• maximum raw procedural score if cholangiogram performed: 100

• maximum raw procedural score if cholangiogram not performed: 80

• minimum error score: 0

• maximum error score: > 100

• The optimal final score is 100%.

• A seriously flawed procedure could have a large negative number.

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Description

Specialty

ICD-10