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The effect of laparoscopic cholecystectomy on resident training
P R Schauer1, C P Page, R M Stewart
1Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842.
Background:
The purpose of this study was to determine the impact of laparoscopic cholecystectomy (LC) on resident training.
Materials And Methods:
We reviewed our experience over an 11-year period, from academic years 1982 to 1992, with 3,046 patients who underwent elective open cholecystectomy (OC) and 640 patients who underwent LC.
Results:
Prior to LC, junior residents performed 80% of all cholecystectomies, with a morbidity and mortality rate of 4% and 0.04%, respectively, compared with 11% and 0.3%, respectively, for senior residents who operated on higher-risk patients. Since the introduction of the technique, there has been a 25% increase in cholecystectomies per year, and a reduction in junior resident OC experience by 67%. Currently, 72% of all cholecystectomies are performed laparoscopically by senior residents.
Conclusion:
The replacement of OC by LC has produced a qualitative change in the operative experience of our junior residents and a delay in acquisition of operative skills. The reduction in OC experience by residents may jeopardize their ability to perform the difficult open cases.