Smart Intraoperative Reminder to Implement Safety Principles in Laparoscopic Cholecystectomy

NCT ID: NCT06895200

Last Updated: 2025-04-30

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-04-03
• Study Completion Date: 2026-05-31

Brief Summary

The Critical View of Safety (CVS) is universally recommended to prevent bile duct injuries in laparoscopic cholecystectomy. However, CVS is underutilized and bile duct injuries are not decreasing. The CVS-Notifier SaMD (Software as a Medical Device) reminds surgeons to verify the CVS before dividing the cystic duct, as recommended by guidelines. It is hypothesized that this systematic and timely reminder could improve the implementation of CVS without disturbing surgical workflows.

Detailed Description

Laparoscopic cholecystectomy is the gold standard approach for the surgical removal of the gallbladder. However, between 0.3 and 1.5% of patients undergoing laparoscopic cholecystectomy experience a bile duct injury (BDI). This major complication translates into a threefold increase in mortality at 1 year, frequent medico-legal litigations, and an annual cost of about 1 billion dollars in the USA alone.

The visual perceptual illusion causing major BDIs can be prevented by implementing the Critical View of Safety (CVS). CVS consists of the clearance of the hepatocystic triangle from fat and connective tissue, the division of the lower part of the gallbladder from its liver bed, and ensuring that only two tubular structures-the cystic duct and the cystic artery-connected to the gallbladder are visible. Unfortunately, CVS implementation in surgical practices is as low as 9% and, in turn, BDIs do not decrease.

To improve the implementation of the CVS, multi-society consensus guidelines recommend to time-out to confirm CVS achievement before dividing cystic structures. A large quality improvement study demonstrated that a short time-out to recall CVS principles significantly increases CVS implementation rates. However, the implementation of the time-out and CVS decreases over time.

The CVS-Notifier SaMD reminds surgeons to time-out to verify the CVS before the division of the cystic duct. Such a systematic intraoperative reminder to implement best practices could help consistently perform safe laparoscopic cholecystectomies.

This first-in-human, exploratory study aims at evaluating the safety, usability, and potential impact of the CVS-Notifier SaMD in laparoscopic cholecystectomy.

The study is a single center, non-comparative, case series. Patients undergoing elective laparoscopic cholecystectomy who meet the eligibility criteria and express their consent to participate in the study will be enrolled. The CVS-Notifier SaMD will be installed on a medical grade computer connected to a secondary output of the laparoscopic video system (input) and to an auxiliary screen in the operating room (OR) (output). Surgeons will start the procedure as usual while the CVS-Notifier SaMD unobtrusively analyses the surgical video. When the beginning of the hepatocystic triangle dissection is detected, a visual reminder to verify CVS in an intraoperative time-out notification will appear on the auxiliary OR screen.

Surgeons and patients will be asked to fill in a survey to report their experience, after the procedure and before discharge, respectively.

Clinical, surgical, and device-related data will be collected and analyzed.

Conditions

Cholecystectomy, Laparoscopic

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: DEVICE_FEASIBILITY
• Blinding Strategy: NONE

Study Groups

Study

Group Type: EXPERIMENTAL

CVS-Notifier SaMD

Intervention Type: DEVICE

The CVS-Notifier SaMD reminds surgeons to time-out to check the CVS before the division of the cystic duct.

Interventions

CVS-Notifier SaMD

The CVS-Notifier SaMD reminds surgeons to time-out to check the CVS before the division of the cystic duct.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Man or woman over 18 years old.
• Patient presenting with benign gallbladder disease requiring an elective laparoscopic cholecystectomy.
• Patient without contraindications to anaesthesia or laparoscopic cholecystectomy surgery.
• Patients capable of understanding and providing their written consent to the study.
• Patient affiliated to the French social security system.

Exclusion Criteria

• Patients presenting with malignant gallbladder disease requiring an elective laparoscopic cholecystectomy.
• Pregnant or lactating patient.
• Patient in exclusion period (determined by a previous or a current study).
• Patient under guardianship or trusteeship.
• Patient under the protection of justice or deprived of liberty.
• Patient in situation of emergency.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Scialytics SAS

UNKNOWN

Sponsor Role: collaborator

IHU Strasbourg

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Silvana PERRETTA, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Hopitaux Universitaires de Strasbourg

Locations

Visceral and Digestive Surgery, Nouvel Hôpital Civil

Strasbourg, , France

Site Status: RECRUITING

Countries

France

Central Contacts

Armelle TAKEDA, PhD

Role: CONTACT

armelle.takeda@ihu-strasbourg.eu

+33341903608

Facility Contacts

Silvana PERRETTA, MD, PhD

Role: primary

silvana.perretta@chru-strasbourg.fr

+33369550531

Other Identifiers

24-001

Identifier Type: -

Identifier Source: org_study_id