Abstract
Background The present study assesses the educational value of laparoscopic cholecystectomy
videos on YouTube regarding the correct application of the critical view of safety
(CVS), and evaluates… surgical trainees' perceptions of the CVS criteria in a simulated,
operative decision-making exercise.
Methods YouTube was systematically searched for laparoscopic cholecystectomy videos, explicitly
reporting a satisfactory CVS. The top 30 most popular videos, by number of views,
were identified and scored on the 6-point scale by three experienced consultants.
After watching a training module on CVS rationale and criteria, 10 trainees, blinded
to the consultants' assessment, were instructed to view the videos, score each criterion
and answer the binary question “Would you divide the cystic structures?” by “yes”
or “no.”
Results An inadequate CVS was found in 30% of the included videos. No statistical association
was noted between number of views, likes, or dislikes with successful CVS rates. Inter-observer
agreement between consultants and trainees ranged from minimal to moderate (k = 0.07–0.60). Discrepancy between trainees' CVS scores and their simulated decision
to proceed to division of the cystic structures was found in 15% of assessments, with
intra-observer agreement ranging from minimal to excellent (k = 0.27–1.0). For the CVS requirements, inter-observer agreement was minimal for the
dissection of the cystic plate (k = 0.26) and triangle clearance (k = 0.39) and moderate for the identification of two and only two structures (k = 0.42).
Conclusion The CVS is central to the culture of safety in laparoscopic cholecystectomy. Surgical
videos are a useful training tool as simulated, operative decision-making exercises.
However, public video platforms should be used judiciously, since their content is
not peer-reviewed or quality-controlled.
Keywords surgical training - laparoscopic cholecystectomy - bile duct - critical view of safety
(CVS).
