Safety of laparoscopic cholecystectomy on a teaching service: a prospective trial

In a prospective audit of our first 213 laparoscopic cholecystectomies (LC), we compared the results obtained by qualified surgeons to those obtained by residents. The first group started performing LC after undergoing formal laboratory laparoscopic courses. The second group was introduced to LC by standard attending-resident teaching in the operating room. In all, 137 LC wer performed by qualified surgeons and 76 by residents. Patients' clinical and laboratory characteristics were not significantly different in the two groups. The conversion rate to laparotomy (11.5% and 12.5%), mean duration of surgery (88 and 83 min), iatrogenic perforation of the gallbladder (16% and 18.5%), "lost stones" (7% and 4%), use of drains (12% and 13%), and extension of the umbilical port incision (about 30% in both groups) were similar in the two groups. The incidence of biliary (3% and 4%) and infectious (3.5% and 4%) complications was equivalent in both groups. We conclude that with the traditional attending-resident approach to surgical education, residents safely and quickly acquire the necessary skills to perform LC without jeopardizing the safety of patients.