Laparoscopic cholecystectomy performed by surgical trainees

The aim of this study was to assess morbidity, mortality, and outcome in select patients after laparoscopic cholecystectomy performed by consultants or by Specialist Registrars (SpRs) and Senior House Officers (SHO), in the General Hospital of Ioannina 'G. Hatzikosta' in northwestern Greece.

Between January 1, 2001 and December 31, 2005, 1370 laparoscopic cholecystectomies were performed, 445 (33%) by SpRs and SHO and 925 (67%) by consultants. Patients included 982 (71.3%) women and 388 (28.7%) men. The mean age was 46.2 years (range, 17 to 79). All patients had routine blood tests (including liver function tests), electrocardiography, chest x-ray, and abdominal ultrasound scan performed preoperatively. All patients received a general anesthesia, and the standard Reddick and Olsen technique was performed. The Harmonic scalpel was used in all cases.

Four conversions (0.3%) were required to an open procedure, (2 in the SpRs and SHO group and 2 in the group of consultants), because of impossible recognition of anatomy around Calot's triangle. The mean operative time was 57 minutes (range, 33 to 97) for SpRs and SHO, while for the consultants it was 49 minutes (range, 27 to 78, P=0.25). Mortality rate was 0% in both groups. There were 44 major complications (2.7%), 17 in the SHO and SpRs group (3.7%) and 27 in the consultant group (1.7%, P=0.11). The complications included bowel thermal injury (consultants [cons], 1; residents [res], none); bile duct injury (cons, 1; res, none); bile leak (cons, 3; res, 5); hemorrhage (cons, 2; res, 2); hematomas at the trocar sites (cons, 5; res, 4); inflammation of the port site at the umbilicus (cons, 4; res, 5); paralytic ileus (cons, 4; res, 3); and hemorrhage from the subxiphoid trocar (cons, 2; res, 3), which stopped spontaneously. The mean hospital stay was 1.3 days, while all the patients resumed their normal activities after 11.7 days (range, 7 to 19).

Supervised laparoscopic cholecystectomy performed by trainees does not increase surgical morbidity and does not compromise surgical outcome.