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

Abstract

Purpose: The aim of this study was 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 carried out 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 the two groups. However the patients operated on by surgical residents had significantly longer operation time (40.7 vs 63.7 min, p˂0.05). Conclusions: 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.