Who Will Be Able to Perform Open Biliary Surgery in 2025?

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Biliary Tract Surgery

Background:

• Laparoscopic cholecystectomy (LC) is the standard of care for gallbladder removal.
• Open cholecystectomy (OC) remains necessary for select patient cases.
• This study examines trends in OC performance by surgical residents over three decades.

Purpose of the Study:

• To evaluate the changing volume of open cholecystectomies (OC) performed by graduating general surgery residents.
• To assess the impact of laparoscopic cholecystectomy (LC) adoption on resident training in open biliary procedures.
• To identify the need for updated surgical training paradigms.

Main Methods:

• Retrospective review of cholecystectomy data from 1981-2013 across three distinct eras.
• Analysis of open cholecystectomies (OC), intraoperative cholangiograms (IOC), and common bile duct explorations (CBDE) performed by residents.
• Statistical analysis using chi-square or Fisher's exact test to compare procedural volumes across decades.

Main Results:

• A significant decrease in OC procedures was observed, declining by 67% in the first decade of LC and 92% in the most recent decade.
• Mean OCs per graduating resident dropped from 70.4 in the pre-laparoscopic era to 3.6 in the recent LC decade.
• In the last decade, IOC and CBDE rates were 8.8% and 0.5% respectively; inclusion of affiliated institutions showed increased mean OCs, IOCs, and CBDEs per resident.

Conclusions:

• There has been a substantial decline in resident exposure to open cholecystectomy (OC), intraoperative cholangiogram (IOC), and common bile duct exploration (CBDE) over 30 years.
• Current training paradigms require revision to address the decreased volume of these procedures.
• Recommendations include focused training on IOC/CBDE during LC, high-quality simulation for OC/IOC/CBDE, and advanced video resources.