Laparoscopic cholecystectomy in a surgical training programme

Abstract

Objective: To assess the impact of the introduction of the laparoscopic cholecystectomy on surgical training, and the outcome of laparoscopic cholecystectomies performed by residents compared with those of surgeons.

Design: Retrospective analysis.

Setting: University hospital, The Netherlands.

Subjects: 943 Patients who underwent cholecystectomies from January 1987-December 1993 by residents and surgeons. In 527 patients the cholecystectomy was open and in 416 laparoscopic.

Main outcome measures: The percentage of cholecystectomies done by residents in the period 1987-1993. The outcome of laparoscopic cholecystectomies done by surgeons and residents in terms of duration of operation, conversion rate, postoperative complications, and hospital stay.

Results: Before the laparoscopic era about 70% of all cholecystectomies were done by residents. After its introduction in 1990, the residents did 38% of the laparoscopic cholecystectomies in 1991, 39% in 1992, and 64% in 1993. There were no differences in outcome of laparoscopic cholecystectomy in terms of duration of operation, conversion rate, postoperative complications and hospital stay between surgeons and residents.

Conclusions: The introduction of laparoscopic cholecystectomy caused a temporary decline in the number of cholecystectomies done by residents. Laparoscopic cholecystectomy was integrated as a standard surgical procedure in the residents' training programme within two years of its introduction. The outcome of laparoscopic cholecystectomies done by supervised residents and surgeons was similar, and so laparoscopic cholecystectomy should be part of residents' training.