{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:05:12Z","timestamp":1791353112751,"version":"4.3.1"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prevention of bile duct injury and vasculo\u2010biliary injury while performing laparoscopic cholecystectomy (LC) is an unsolved problem. Clarifying the surgical difficulty using intraoperative findings can greatly contribute to the pursuit of best practices for acute cholecystitis. In this study, multiple evaluators assessed surgical difficulty items in unedited videos and then constructed a proposed surgical difficulty grading.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We previously assembled a library of typical video clips of the intraoperative findings for all LC surgical difficulty items in acute cholecystitis. Fifty\u2010one experts on LC assessed unedited surgical videos. Inter\u2010rater agreement was assessed by Fleiss's\n                      <jats:italic>\u03ba<\/jats:italic>\n                      and Gwet's agreement coefficient (AC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Except for one item (\u201cedematous change\u201d),\n                      <jats:italic>\u03ba<\/jats:italic>\n                      or AC exceeded 0.5, so the typical videos were judged to be applicable. The conceivable surgical difficulty gradings were analyzed. According to the assessment of difficulty factors, we created a surgical difficulty grading system (agreement probability\u00a0=\u00a00.923,\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u00a0=\u00a00.712, 90% CI: 0.587\u20100.837; AC\n                      <jats:sub>2<\/jats:sub>\n                      \u00a0=\u00a00.870, 90% CI: 0.768\u20100.972).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The previously published video clip library and our novel surgical difficulty grading system should serve as a universal objective tool to assess surgical difficulty in LC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.1068","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T11:01:05Z","timestamp":1636369265000},"page":"758-767","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Application of a novel surgical difficulty grading system during laparoscopic cholecystectomy"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4068-3622","authenticated-orcid":false,"given":"Koji","family":"Asai","sequence":"first","affiliation":[{"name":"Department of Surgery Toho University Ohashi Medical Center  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukio","family":"Iwashita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine  Oita 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Clinical Education and Training Center University of Tsukuba Hospital  Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-3933","authenticated-orcid":false,"given":"Yasuhisa","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Surgery 1 School of Medicine University of Occupational and Environmental Health  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaharu","family":"Higashida","sequence":"additional","affiliation":[{"name":"Department of Digestive Surgery Kawasaki Medical School  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Kumamoto","sequence":"additional","affiliation":[{"name":"Department of General, Pediatric and Hepatobiliary\u2010Pancreatic Surgery Kitasato University School of Medicine  Kanagawa 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