Residents' performance in open versus laparoscopic bench-model cholecystectomy in a hands-on surgical course

Laparoscopy has become the gold standard for many abdominal procedures. Among young surgeons, experience in laparoscopic surgery increasingly outweighs experience in open surgery. This study was conducted to compare residents' performance in laparoscopic versus open bench-model task.

In an international surgical skills course, we compared trainees' performance in open versus laparoscopic cholecystectomy in a cadaveric animal bench-model. Both exercises were evaluated by board-certified surgeons using an 8-item checklist and by the trainees themselves.

238 trainees with a median surgical experience of 24 months (interquartile range 14-48) took part. Twenty-two percent of the trainees had no previous laparoscopic and 62% no previous open cholecystectomy experience. Significant differences were found in the overall score (median difference of 1 (95% CI: 1, 1), p < 0.001), gallbladder perforation rate (73% vs. 29%, p < 0.001), safe dissection of the Calot's triangle (98% vs. 90%, p = 0.001) and duration of surgery (42 (13) minutes vs. 26 (10) minutes (mean differences 17.22 (95% CI: 15.37, 19.07), p < 0.001)), all favouring open surgery. The perforation rate in open and laparoscopic cholecystectomies was not consistently decreasing with increasing years of experience or number of previously performed procedures. Self-assessment was lower than the assessment by board-certified surgeons.

Despite lower experience in open compared to laparoscopic cholecystectomy, better performance was observed in open task. It may be explained by a wider access with easier preparation. Open cholecystectomy is the rescue manoeuvre and therefore, it is important to provide also enough training opportunities in open surgery.