Safety of teaching laparoscopic cholecystectomy to surgical residents

As laparoscopic cholecystectomy evolves into the "standard" method for gallbladder removal, it has become necessary for surgical residents to safely acquired the necessary skills to perform the procedure. To determine the safety of this procedure in the hands of residents, the authors evaluated the first 100 attempted laparoscopic cholecystectomies performed by a resident in the role of "surgeon." Ninety-one of the 100 procedures were successfully completed laparoscopically and 9 required conversion to laparotomy: 5 technically difficult cases, 2 common duct explorations, and 2 for intraoperative complications. At Cooper Hospital in New Jersey, essentially all patients requiring cholecystectomy are first attempted laparoscopically. Seventy-seven patients had chronic cholecystitis and 23 had acute disease. Twenty-two patients had intraoperative cholangiograms and two had laparoscopic common bile duct exploration. For the laparoscopically-completed procedures, average operative time was 91 min and showed a downward trend as each resident gained experience. Three (3%) major complications occurred: one colon laceration, one common bile duct injury, and one postoperative bile collection. For the 91 laparoscopically-completed procedures, 53 patients were discharged on postoperative day 1 and 20 on postoperative day 2. Average postoperative hospitalization was 1.7 days. Overall, these results were comparable to those reported in the literature by attending and private surgeons. The authors conclude that laparoscopic cholecystectomy can be performed safely by supervised residents acting as primary surgeon with outcomes similar to those obtained by trained attending surgeons.