Is Elective Laparoscopic Cholecystectomy a Safe Supervised Teaching Procedure?

H. Rodolfo Scaravonati, MD, Carlos Augusto Cutini, MD, Silvina Lucia Milletari, MD, Patricio E. Donnelly, MD, Nicolas Ortiz, MD, Rodrigo Moran Azzi, MD, FACS, Victor Hugo Serafini, MD, FACS, Gintaras Antanavicius, MD, FACS

Sanatorio Guemes

Introduction: Laparoscopic cholecystectomy for symptomatic cholecystolithiasis is a standard procedure and the most common laparoscopic intervention in general surgery. During the introduction and standarisation of the procedure was generally confined to experienced surgeons. In 1994 Hodgson et al. stated that there was a need for a higher level of skill when laparoscopic cholecystectomy (LC) is compared with open cholecystectomy. There are still few studies that have investigated the outcome of LC done by a resident under supervision by an experienced laparoscopic surgeon. The aim of this study is to evaluate the safety of elective laparoscopic cholecystectomy (LC) as a supervised teaching procedure

Methods and Procedures: Retrospective analysis from a prospectively collected database. We included all patients undergoing elective laparoscopic cholecystectomy between January 2010 and December 2010. We divided into two groups according to the surgeon (residents or staff surgeons). Operative time, rate of conversion, major complications and mortality were analyzed and compared. We used SPSS 15.0. Statistical significance was considered p<0.05

Results: A total of 476 laparoscopic elective cholecystectomies were performed between January 2010 and December 2010 (280 female; 196 male). The average age was 45.6 years (range: 16-88). Procedures performed by residents as the principal surgeon were 302 (% 63). Mean operative time was: Residents: 65 min (range 20-120) vs Staffs: 56.5 min (range 15-90). No significant difference existed in conversion rates. Morbidity rate was 4.3% (n = 13) in residents group vs 3.4% (n = 6) on the staff group. No deaths occurred in this study.

Conclusion: There were no statistically significant differences in the conversion rate and morbidity in both groups. In addition, the operative time was statistically significant (p=0.042), but was not associated with a higher morbidity. Thus, elective laparoscopic cholecystectomy done by residents proved to be a safe procedure with acceptable morbidity and extremely low mortality.

Session: Poster Presentation

Program Number: P368