Could resident surgeons safely perform laparoscopic cholecystectomy for acute cholecystitis?

Masahiro Iseki1, Atsushi Kouyama1, Takeshi Naitoh2, Daisuke Takeyama1, Akefumi Sato1, Izuru Minemura1, Shigeru Ottomo1, Masato Oohara1, Kazuaki Hatsugai1, Hirofumi Ichikawa1, Iwao Kaneda1. 1Department of Surgery, Japanese Red Cross Ishinomaki Hospital, 2Department of Surgery, Tohoku University Graduate School of Medicine

Background: Our hospital is located at the Ishinomaki area, where the Great East Japan Earthquake directly hit at 2011. There is no central hospital except our hospital after the disaster in this area, and we treat many emergency patients including acute cholecystitis. A lot of resident surgeons belong to our hospital and we put a strong effort to the education for surgical residents. In our hospital, surgical residents, who have experienced a plenty of eligible laparoscopic cholecystectomy (LC) for gallstone, are allowed to conduct advanced LC for acute cholecystitis for educational purposes.

Purpose: The aim of this study was to evaluate the validity of our educational policy whether surgical residents could manage the LCs for acute cholecystitis.

Method: A total of 61 patients were evaluated retrospectively, who received LC for acute cholecystitis in our hospital between April 2014 and March 2015. According to their operator, all patients were divided into 2groups: a residents group and an attending group. All procedures in residents group were carried out under the guidance of the advisory surgeon. The clinical characteristics and severity of cholecystitis were assessed as backgrounds of patients. The postoperative outcomes were also analyzed to compare the surgical qualities of each group.

Result: There was no significant difference about clinical characteristics including gender, age and comorbidity. White blood cell count (residents group vs. attending group: 13290±5277 cells/mm3 vs. 13035±4988 cells/mm3 (P=0.95)), C-reactive protein (11.4±11.7 mg/dl vs. 15.2±14.2 mg/dl (P=0.11)) and Tokyo Guideline 13 severity (Grad1/2/3: 21/13/4 vs. 9/11/3 (P=0.39)) were not found to be significantly different. The duration of residents’ operation was longer than attendings’ (174.5±52.5 min vs. 139.4±38.68 min (P=0.03)). Blood loss (105.9±156.8 g vs. 274.8±405.2 g (P=0.10)), rate of conversion to open surgery (13.2% vs. 13.0% (P=1.00)), postoperative complication (13.2% vs. 17.4% (P=0.48)) and postoperative hospital stay (5.4±3.4 days vs. 6.8±6.4 days (P=0.75)) didn’t show significant differences.

Discussion: Comparing 2groups, there was no significant difference about preoperative characteristics and severity of cholecytitis. Our results indicated that the safety and therapeutic effect of each group were nearly equal except the duration of operation.

Conclusion: Although it was necessary to be guided by advisory surgeons, residents could safely perform LC for acute cholecystitis and these experiences might be beneficial to acquire laparoscopic surgery technique.

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