Surgical laparoscopic experience during the first year on a teaching service

Recently, general surgeons have become actively involved in laparoscopic operations. The best method for teaching these techniques to surgical residents is unclear. Since June 1990, at St. Luke's-Roosevelt Hospital Center in New York City, we have instituted a formal course of instruction for surgical residents. This includes a reference syllabus, didactic instruction, use of an inanimate training device and a hands-on practice in swine. Clinically, the residents progress from observer to camera operator and, finally, operator. During the first year of this program, the authors performed 90 laparoscopic cholecystectomies, of which 71 were elective and 19 were for acute cholecystitis. There were seven morbidly obese patients, while 25 had undergone prior abdominal operations. The first 25 operations performed by the authors averaged 93.2 minutes, while the last 40 operations performed primarily by the surgical residents with assistance of the authors averaged 70 minutes. There were nine complications, including postoperative pancreatitis in two patients, Clostridium difficile enterocolitis in two and one each of prolonged paralytic ileus, postoperative transfusion and umbilical incision dehiscence. Two patients had postoperative common duct stones. There were no wound infections, bile duct injuries or deaths. Complications were evenly distributed throughout the series and did not correlate with whether the surgeon was a resident or an attending surgeon. The results of this plan have been quite successful and thus far, 12 residents have completed this program.