Canadian laparoscopic surgery survey

To assess the status of laparoscopic general surgery in Canada and the training experience and educational needs of Canadian surgeons, particularly with laparoscopic cholecystectomy (LC).

All of Canada's practising general surgeons were surveyed by mail approximately 15 months after the general availability of laparoscopic video equipment. Questionnaires completed by 736 surgeons form the basis of the analysis.

The respondent profile produced a good sample distribution to assess differences related to age, experience, location and type of practice; 30% practised in communities of 50,000 or less; 38% in hospitals with 250 or fewer beds and 57% in community hospitals.

Eighty-four percent had already learned LC, and 51% of them had performed more than 25 LCs. The number performed correlated directly with the number of cholecystectomies usually performed yearly before laparoscopy. Age and lack of relevance to practice were reasons for not learning. Ninety-one percent took formal training courses, usually university sponsored and in Canada. Complications were experienced by 44% of respondents. Bile leak (26%), hemorrhage (15%) and bile-duct injury (9%) were the most common and increased as the number of cholecystectomies usually performed prior to LC increased. Age, sex, type and location of hospital and size of city were not significant factors. The data show a consistent (p < 0.001) increase in the proportion of surgeons who encountered a complication as the number of LCs performed increased.

LC has been introduced in Canada in an unpredicted, rapid and seemingly orderly and responsible fashion in all areas, types and sizes of communities. It has been equally well applied by surgeons of all ages and size of practice whether practising in the smaller community or in the university centre. The dogma of complications related to a "learning curve" is not supported by the author's data, and experience with complications is not restricted to the occasional biliary surgeon. Continued vigilance is necessary.