Teaching laparoscopic cholecystectomy: do beginners adversely affect the outcome of the operation?

Abstract

Objective: To evaluate the safety of elective laparoscopic cholecystectomy (LC) as a supervised teaching procedure.

Design: Prospectively documented series, retrospective analysis.

Setting: University teaching hospital, Austria.

Subjects: 581 consecutive patients who underwent elective LC for symptomatic cholelithiasis between January 1993 and December 1997.

Interventions: LC were allocated to three groups: the first (n = 91) were done by supervised beginners (who had done fewer than 11 LC), the second (n = 249) by supervised trainees who had a little experience (they had done more than 10 but fewer than 51 LC), and the third group (n = 241) who were experienced surgeons (they had done more than 50 LC).

Main outcome measures: Minor and major complications, conversion and reoperation rate, length of operation and postoperative hospital stay.

Results: The minor intraoperative complication rates were 36/91 (40%), 115/249 (46%) and 49/241 (20%), respectively (p < 0.001 when experienced surgeons were compared with the 2 trainees' groups). There were no significant differences between the three groups regarding major complications (1/91, 4/249 and 4/241), conversions (5/91, 21/249, and 17/241) and reoperation rate (1/91, 3/249 and 3/241), median (range) length of operation 82 (24-159), 84 (25-249) and 82 (21-234) minutes and hospital stay 4 (3-19), 4 (3-11) and 4 (2-15) days.

Conclusion: Elective LC for symptomatic cholelithiasis done by trainees under supervision does not increase surgical morbidity.