J Minim Invasive Surg.  2016 Jun;19(2):70-74. 10.7602/jmis.2015.19.2.70.

What is the Safe Training to Educate the Laparoscopic Cholecystectomy for Surgical Residents in Early Learning Curve?

• Jung YK
• Kwon YJ
• Choi D
• Lee KG

• KMID: 2362240
• DOI: http://doi.org/10.7602/jmis.2015.19.2.70

Abstract

PURPOSE
This study was conducted to investigate the safety of laparoscopic cholecystectomy (LC) performed by surgical residents.
METHODS
We reviewed the records of patients who underwent LC for chronic cholecystitis and gallbladder polyps between February 2010 and July 2012. All diagnoses were confirmed by biopsy. All procedures performed by surgical residents were conducted under the close supervision of an experienced laparoscopic surgeon. A standard four-port method was used, and we achieved the critical view of safety in almost all patients.
RESULTS
Of 219 LC procedures, 136 were performed by an experienced laparoscopic surgeon, and 83 by surgical residents. There was no significant difference in postoperative hospital stay (1.1 vs. 1.2 days, p=0.337) or complication rates (3.7% vs. 2.4%, p=0.712) between groups. However, the patients operated on by surgical residents had significantly longer operation times (40.7 vs. 63.7 min, p<0.05).
CONCLUSION
LC performed by inexperienced surgical residents under the supervision of an experienced surgeon is safe and feasible for chronic cholecystitis and gallbladder polyps. Major bile duct injury is strongly correlated with having performed fewer than 20 LC procedures, so surgical residents must secure the critical view of safety, and the supervising surgeon must confirm it before the cystic duct and cystic artery are ligated.

Keyword

Laparoscopic cholecystectomy; Biliary; Training; Surgical resident; Complication

MeSH Terms

Arteries
Bile Ducts
Biopsy
Cholecystectomy, Laparoscopic*
Cholecystitis
Cystic Duct
Diagnosis
Gallbladder
Humans
Learning Curve*
Learning*
Length of Stay
Methods
Organization and Administration
Polyps