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Teaching cholangiography in a surgical residency program
William W Hope1, Lindsay Bools, W Borden Hooks
1Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA. william.hope@seahec.net
Objective:
To evaluate the time associated with routine cholangiography in a residency teaching program.
Design:
We retrospectively reviewed all patients undergoing laparoscopic cholecystectomy with intraoperative cholangiography by a single surgeon from April 2010 to September 2011. Cholangiogram time, demographic, and operative information was recorded, and factors associated with increased cholangiogram times were compared using Fisher's exact test, Kruskal-Wallis test, and linear regression; a p value <0.05 was considered significant.
Setting:
Academic-affiliated community-based surgical residency program.
Participants:
10 surgical residents, PGY 1-5.
Results:
Laparoscopic cholecystectomy with intraoperative cholangiography was performed in 54 patients. The average patient age was 43 years; 69% were Caucasian and 74% were female. Cholangiography was successful in 96% of patients. The average time for cholangiograms performed by residents was 11 minutes (range, 6-22 minutes) and average operating room time was 68 minutes (range, 32-103 minutes). The average percentage of case time for cholangiography was 17% (range, 9%-63%). Minor technical complications related to cholangiograms occurred in 33% of cases, with the most common being difficulty with clipping the catheter (20%). There was no significant difference in completion rate or cholangiogram time based on resident level of experience (p > 0.05).
Conclusions:
Intraoperative cholangiogram can be safely performed by residents at every level during laparoscopic cholecystectomy without adding significant time to the operation.
