SAGES 2026 Annual Meeting Emerging Technology Session

•Cholecystectomy is common, but complexity varies widely

•Current grading systems stratify disease severity, but no standardized method for documenting operative difficulty

•Create a consensus-derived lexicon and evaluate if operative documentation reflects objective case complexity

•Modified Delphi panel developed difficulty terminology

•Retrospective review (Apr-Sep 2024)

•Reports assessed for difficulty markers & intraoperative variables

•Cases graded with: Tokyo, AAST, Parkland, and G10 grading scores

•Correlation between documentation and severity analyzed

•210 cases reviewed

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•Mean difficult terms: 1.27

•Most common terms:

•Inflammation (70)

•Adhesions (67)

•Gangrenous (17)

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•Avg. operative time: 122 min.

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•Longer cases (>120 min) had:

•More difficult terms (2.0 vs 0.7, p<0.0001)

•Higher severity across all grading systems (p<0.0001)

- Operative documentation often underrepresents objective complexity

- Standardized templates incorporating consensus terminology and validated grading systems may improve documentation accuracy, justify resource utilization, and support appropriate reimbursement

SAGES 2026 Annual Meeting Emerging Technology Session

Describing Difficult Gallbladders: Does Operative Documentation Reflect Case Complexity?

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