Feasibility and learning curve of a standardized laparoscopic cholecystectomy technique using a reusable bipolar...

Laparoscopic cholecystectomy (LC) is a common surgical procedure and a key component of surgical training. However, balancing resident education with patient safety remains a challenge. Despite its common use in hepatopancreatobiliary surgery, the role of the reusable bipolar clamp (BiClamp) in LC has not been fully evaluated. This study aims to assess the technical aspects, safety, and learning curve associated with a standardized LC technique using the BiClamp, performed by surgical residents.

A total of 780 consecutive LCs performed by seven surgical residents from 2018 to 2024 were retrospectively analyzed. Only residents without prior LC experience were included. All relevant perioperative outcomes were evaluated. Learning curves were assessed using (risk-adjusted) cumulative sum analyses based on operation time and suboptimal performance, defined as extended operation time, intraoperative complications, or conversion to open surgery.

No intraoperative biliary or vascular injuries occurred. Conversion to open surgery was necessary in only 0.3% of cases. The overall mean operation time was 57.2 ± 16.5 min and suboptimal performance was observed in 10.6% of cases. The learning phase lasted 8-18 procedures, with proficiency reached after 21-97 cases. Risk-adjusted cumulative sum analyses confirmed performance improvements despite increasing case complexity.

LC using the BiClamp is a safe and effective technique for surgical training, with a relatively short learning curve. These findings support its integration into standardized LC protocols for residents, though further multicenter validation is warranted.