Laparoscopic Common Bile Duct Exploration for the Next Generation: A Rationale for Junior Surgeons to Operate

Laparoscopic common bile duct exploration (LCBDE) is regaining popularity in the surgical community over the past 10 years while also being perceived as a difficult procedure to perform. This study aims to explore the feasibility of involving junior surgeons in this procedure.

All adult patients that underwent LCBDE at Northern Health, Australia, between 2008 and 2023 were retrospectively audited.

There were 962 patients identified over the study period. The overall success rate was 84.4%, and the 6-month post-discharge stone recurrence was 3.6%. Junior operators demonstrated a comparably high success rate (87.3%), a short overall operative time (150.0 min, p < 0.001) and a low bile leak rate (0.5%, p = 0.29). On multivariate analysis, junior surgeons as either independent or partial primary operators (Odds Ratio 1.8, 95% CI, 1.1-2.9, p = 0.02) were statistically correlated to a successful outcome without 6-month stone recurrence and not requiring perioperative ERCPs.

Junior surgeons should be actively encouraged to participate and undertake primary operator roles, as the clinical outcomes demonstrate safety and efficacy. As junior surgeons progressively develop competency, LCBDE has the potential to offer value to patients while ensuring the confident transfer of skills to younger surgeons.