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. 2023 Nov;37(11):8755-8763.
doi: 10.1007/s00464-023-10328-y. Epub 2023 Aug 11.

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy

Masahiro Kawamura  1 , Yuichi Endo  2 , Atsuro Fujinaga  2 , Hiroki Orimoto  2 , Shota Amano  2 , Takahide Kawasaki  2 , Yoko Kawano  2 , Takashi Masuda  2 , Teijiro Hirashita  2 , Misako Kimura  3 , Aika Ejima  3 , Yusuke Matsunobu  3 , Ken'ichi Shinozuka  3 , Tatsushi Tokuyasu  3 , Masafumi Inomata  2
Affiliations

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy

Masahiro Kawamura et al. Surg Endosc. 2023 Nov.

Abstract

Background: The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC.

Materials and methods: AI software was developed to evaluate the achievement of CVS using an algorithm for image classification based on a deep convolutional neural network. Short clips of hepatocystic triangle dissection were converted from 72 LC videos, and 23,793 images were labeled for training data. The learning models were examined using metrics commonly used in machine learning.

Results: The mean values of precision, recall, F-measure, specificity, and overall accuracy for all the criteria of the best model were 0.971, 0.737, 0.832, 0.966, and 0.834, respectively. It took approximately 6 fps to obtain scores for a single image.

Conclusions: Using the AI system, we successfully evaluated the achievement of the CVS criteria using still images and videos of hepatocystic triangle dissection in LC. This encourages surgeons to be aware of CVS and is expected to improve surgical safety.

Keywords: Artificial intelligence; Critical View of Safety; Iatrogenic disease; Image classification; Laparoscopic cholecystectomy; Surgical safety.

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