G10 Intraoperative Scoring System for Predicting Outcomes in Laparoscopic Cholecystectomy: A Hospital based Diagnostic Accuracy Study

Abstract

Introduction
Laparoscopic cholecystectomy is the gold standard for treating gallstone disease. The G10 intraoperative scoring system evaluates ten operative parameters, but its utility in low- and middle-income country settings like Nepal remains limited.  This study aims to evaluate the sensitivity, specificity, and overall diagnostic performance in predicting surgical difficulty and conversion to open cholecystectomy using G10 scoring system.

Methods
From July 2025 to January 2026, a diagnostic accuracy study was carried out at Chitwan Medical College's Department of Surgery (CMC-IRC/082/083/006). Using successive sampling, 120 patients undergoing laparoscopic cholecystectomy of age 18 years and above were included. Conversion to an open cholecystectomy was the primary outcome; blood loss, intraoperative complications, operating time, and overall difficulty level were the secondary outcomes. The best cutoff score was found using ROC curve analysis.

Results
The mean operating time increased significantly (71.7±24.95 to 110±11.55 minutes) with increase in G10 scores from moderate to extreme. The rate of conversion was 50% in extreme group but it was only 3.8% in the moderate group. Conversion to open cholecystectomy was significantly correlated positively with G10 score (r = 0.486, p < 0.001). With a 3.50 cutoff, 90.0% sensitivity, and 83.6% specificity, ROC analysis produced an AUC of 0.867.

Conclusion
The G10 intraoperative grading system is a reliable and practical scoring system with high sensitivity and specificity for predicting surgical difficulties and conversion rate, supporting its application in intraoperative decision making.