Learning Laparoscopic Cholecystectomy: a Surgical resident's Insight on Safety and Training During the Initial 151 Cases

Abstract

Laparoscopic cholecystectomy (LC) has been widely performed for gallbladder disease. However, it has potential fatal complications such as vasculo-biliary injury, which are related to inexperience. Therefore, surgical training of surgical residents in safe and accurate LC technique is important. The aim of this study was to investigate the personal learning curve of one resident and to confirm the safety of LC performed by a surgical resident. We retrospectively reviewed 151 patients who underwent LC performed by a single surgical resident at Hanyang University Hospital. Three or four trocars were inserted, and the "critical view of safety (CVS)" was established in all patients. All procedures were supervised by an experienced hepatobiliary and pancreatic surgeon. Of a total 428 LCs during the study period, 151 were performed by a single surgical resident. There were no significant differences between Group A, the surgical resident, and Group B, the experienced surgeon, in open conversion rate (0.7% vs. 3.2%, p = 0.106) and postoperative complications (6.6% vs. 3.3%, p = 0.107). No major complications including vasculo-biliary injury were recorded in either group. Group A had a significantly longer operative time than Group B (62.48 vs. 51.52, p < 0.001). LC performed by the surgical resident was safe although operative time was longer. However, inexperienced surgeons must always remember to confirm the CVS and follow basic laparoscopic surgery techniques during LC. These principles should be taught by attending staff over the learning curve. Lastly, we recommend the "4Ss" (Subject, Standardization, Stepwise approach, Supervision)" for safe and effective training in LC.