Elective Laparoscopic Cholecystectomy--Is It Safe In The Hands Of Residents During Training?

Abstract

The aim of the study was to assess safety of elective laparoscopic cholecystectomy (LC) performed by residents that are undergoing training in general surgery.

Material and methods: A retrospective analysis was conducted on 330 patients operated electively due to cholelithiasis. Patients with acute cholecystitis, choledocholithiasis, undergoing cholecystectomy as a part of more extensive operation and patients with gall-bladder cancer were excluded. Group 1 included patients operated by resident, group 2--by specialist. Duration of operation, mean blood loss, number of major complications, number of conversions to the open technique and conversions of the operator, reoperations and length of hospital stay were analyzed.

Results: Mean operative time overall was 81 min (25 - 170, SD ± 28.6) and 71 min (30-210, SD ± 29.1) in groups 1 and 2 respectively (p=0.00009). Mean blood loss in group 1 was 45 ± 68.2 ml and in group 2 - 41 ± 73.4 ml (p=0.23). Six major complications has occurred (1.81%) - 2 (2%) in group 1 and 4 (1.7%) in group 2. 18 cases (15.5%) of conversion of the operator occurred in group 1, and 6 cases (2.6%) of conversion of the operator happened in group 2. Average LOS was 1.9 days in group 1 and 2.3 days in group 2 (p=0.03979).

Conclusions: Elective LC performed by a supervised resident is a safe procedure. Tactics of "conversion of operator" allowed to prevent major complications. Longer LC by residents is natural during the learning curve. Modifications of residency program in the field of laparoscopy may increase its accessibility.