Agenda

Saturday, October 20, 2018

7:00am – 4:45pm	Registration
7:30am – 8:00am	Continental Breakfast
8:00am – 8:05am	Introduction and goals for the consensus conference
8:05am – 8:20am	Overview of laparoscopic cholecystectomy and BDI as a public health problem
8:20am – 8:30am	Overview of key PICO (Population, Intervention, Comparator, Outcome) questions on BDI prevention
8:30am – 8:40am	Description of the methodology used to frame and answer the key questions
8:40am – 8:50am	Description of the methodology for conducting the consensus meeting and gaining expert consensus on the key questions for which there are poor or little data
8:50am – 10:15am	Presentation and review of the literature findings and recommendations for key questions. Each section will include: Summary of relevant literature review and consensus recommendations Discussion and audience response with voting Discussion of gaps and future steps Group 1: PICO Questions: BDI Prevention and Anatomic Identification PICO 1. Should one technique of anatomical identification (critical view of safety) versus another be used for limiting the risk or severity of bile duct injury in patients undergoing laparoscopic cholecystectomy? PICO 2. Should the top-down technique of complete cholecystectomy versus subtotal cholecystectomy be used for limiting the risk or severity of bile duct injury when the critical view of safety cannot be achieved? PICO 3. Should requirements for one type of documentation of the critical view of safety (photos) versus another (operative notes or video) are no documentation requirement be used for limiting the risk of severity of bile duct injury during cholecystectomy?)
10:15am – 10:30am	Break
10:30am – 12:15pm	Presentation and review of the literature findings and recommendations for key questions cont. Group 2: PICO Questions: Imaging and Prevention of Biliary Injury PICO 4. Should intraoperative biliary imaging (cholangiography, ultrasound, infrared cholangiography close) versus no imaging be used for limiting the risk or severity of bile duct injury during cholecystectomy? PICO 5. Should one type of intraoperative biliary imaging versus alternative biliary imaging be used for limiting the risk or severity of bile duct injury during cholecystectomy? Group 3: PICO Questions: Biliary Injury and Disease Factors PICO 6. Should surgical (complexity) risk stratification (risk factors or risk prediction models) guided surgery vs alternative risk stratification or no risk stratification guided surgery be used for limiting the risk or severity of bile duct injury in candidates for cholecystectomy? PICO 7. Should surgery guided by prior risk stratification that accounts for cholecystolithiasis vs no risk stratification or alternative risk stratification be used? PICO 9. Should subtotal cholecystectomy vs total laparoscopic or open cholecystectomy be used for limiting the risk or severity of bile duct injury in patients who at the time of their operation have marked acute local inflammation or chronic cholecystitis with biliary inflammatory fusion (BIF) of tissues and tissue contraction?
12:15pm – 1:00pm	Lunch
1:00pm – 3:00pm	Presentation and review of the literature findings and recommendations for key questions cont. Group 4: PICO Questions: Biliary Injury and Disease Factors PICO 8. Should immediate cholecystectomy (within 72 hrs from symptom onset) vs cholecystectomy delayed beyond 72 hours (but <10 days from symptom onset) vs cholecystectomy delayed beyond 6 weeks vs cholecystectomy delayed beyond 12 weeks be used for patients with acute cholecystitis? PICO 11. Should interval/delayed laparoscopic cholecystectomy vs no additional treatment be used for patients previously treated by cholecystostomy and high co-morbidity score (Charleson 6 or>ASA3/ASA4)? Group 5: PICO Questions: Biliary Injury and Alternative Surgical Techniques PICO 10. Should standard 4-port lap cholecystectomy vs SILS laparoscopic cholecystectomy vs robotic cholecystectomy vs open cholecystectomy vs other technique be used for limiting the risk or severity of bile duct injury in candidates for cholecystectomy? PICO 12. Should conversion of laparoscopic cholecystectomy to open cholecystectomy vs no conversion be used for limiting the risk or severity of bile duct injury during difficult laparoscopic cholecystectomy? PICO 13. Should surgeons taking a time out to verify the critical view of safety vs no time out be used for limiting the risk or severity of bile duct injury? PICO 14. Should two surgeons vs one surgeon be used for limiting the risk or severity of bile duct injury? Group 5: PICO Questions: Biliary Injury and Education and Training Factors PICO 15. Should critical view of safety coaching of surgeon vs no specific critical view of safety coaching be used for limiting the risk or severity of bile duct injury? PICO 16. Should training of surgeons by simulation method or video-based education vs alternatively surgeon training be used for limiting the risk or severity of bile duct injury? PICO 17. Should more surgeon experience vs less surgeon experience be used for limiting the risk or severity of bile duct injury?
3:00pm – 3:20pm	Break
3:20pm – 3:50pm	Presentation and review of the literature findings and recommendations for key questions cont. Group 6: PICO Question: Management of Acute BDI PICO 18. Should immediate reconstruction by the operating surgeon vs referral to a specialty center be used for patients with bile duct injury during laparoscopic cholecystectomy?
3:50pm – 4:30pm	Summary of consensus recommendations for each key question and next steps
4:30pm – 4:45pm	Closing Remarks