Advanced laparoscopic fellowship training decreases conversion rates during laparoscopic cholecystectomy for acute biliary diseases: A retrospective cohort study

Abelson, Jonathan S.; Afaneh, Cheguevara; Rich, Barrie S.; Dakin, Gregory; Zarnegar, Rasa; Fahey, Thomas J.; Pomp, Alfons

doi:10.1016/j.ijsu.2014.12.016

Cited by 29 publications

(27 citation statements)

References 21 publications

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“…In human medicine, MIS experience and level of training influences complications and conversion to open laparotomy. 22,23 While cases included in this study may have been part of the learning curve for multiport laparoscopy (and LAG) for some surgeons and/or residents, as evidenced by a high abdominal access complication rate, we believe our procedural complication and conversion rate is low, consistent with previous reports of LAG. 10,16 We had an overall postoperative complication rate of 34% (15/44).…”

Section: Discussionsupporting

confidence: 86%

Long‐Term Outcome and Complications Following Prophylactic Laparoscopic‐Assisted Gastropexy in Dogs

et al. 2016

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Section: Discussionsupporting

confidence: 86%

Long‐Term Outcome and Complications Following Prophylactic Laparoscopic‐Assisted Gastropexy in Dogs

et al. 2016

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“…In a similar study comparing consultant surgeons, trainee surgeons, and trained surgeons, the authors found that there were no differences among the three groups in conversion rates, bile duct injury rates, general complication rates, or length of stay; however, the duration of operation in the trainee surgeons was significantly longer compared to the other two groups [21]. In the setting of LC for acute cholecystitis, Abelson et al reported that advanced laparoscopic fellowship-trained surgeons had significantly lower conversion rate and shorter operative time than the nonfellowship-trained surgeons; however, the complication rates were not significantly different [22]. …”

Section: Discussionmentioning

confidence: 99%

Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital

Atta

Mohamed

Sewefy

et al. 2017

Gastroenterology Research and Practice

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Laparoscopic cholecystectomy (LC) is one of the first laparoscopic procedures performed by surgical trainees. This study aims to determine preoperative and/or intraoperative predictors of difficult LC and to compare complications of LC performed by trainees with that performed by trained surgeons. A cohort of 180 consecutive patients with cholelithiasis who underwent LC was analyzed. We used univariate and binary logistic regression analyses to predict factors associated with difficult LC. We compared the rate of complications of LCs performed by trainees and that performed by trained surgeons using Pearson's chi-square test. Patients with impacted stone in the neck of the gallbladder (GB) (OR, 5.0; 95% CI, 1.59–15.77), with adhesions in the Triangle of Calot (OR, 2.9; 95% CI, 1.27–6.83), or with GB rupture (OR, 3.4; 95% CI, 1.02–11.41) were more likely to experience difficult LC. There was no difference between trainees and trained surgeons in the rate of cystic artery injury (p = .144) or GB rupture (p = .097). However, operative time of LCs performed by trained surgeons was significantly shorter (median, 45 min; IQR, 30–70 min) compared with the surgical trainees' operative time (60 min; IQR, 50–90 min). Surgical trainees can perform difficult LC safely under supervision with no increase in complications albeit with mild increase in operative time.

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“…Failure of the contrast to opacify the common hepatic duct and the right and left hepatic ducts would signal the surgeon that the CBD, not the cystic duct, has been cannulated [74]. The use of IOC is associated with a 62% reduction in CTO rate (OR = 0.38, 95% CI: 0.17-0.94; P = 0.04) [75]. If IOC does not facilitate unmistakeable biliary ducts recognition, then CTO is indicated [74].…”

Section: Intraoperative Patient-related Risk Factorsmentioning

confidence: 99%

“…Surgeon's knowledge, laparoscopic fellowship training, operative experience and skills in laparoscopic surgery play an important role in timely recognition of the need for CTO and are important predictors for CTO [49,74,75,78]. Surgical registrars (postgraduate year 4-5) have a twofold higher rate of CTO (OR = 1.7; 95% CI: 1.1-2.5; P = 0.0067) than surgical consultants [25].…”

Section: Surgeon-related Risk Factorsmentioning

confidence: 99%

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

Beliaev¹,

Booth²

2016

Actual Problems of Emergency Abdominal Surgery

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Background: Laparoscopic cholecystectomy is the preferred surgical operation for symptomatic gallstone disease. Conversion of laparoscopic cholecystectomy to open surgery is used to prevent intra-abdominal organ injury, for open common bile duct exploration and to repair intra-abdominal organ injury. Objective:The objective of this chapter is to review risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery, and surgical quality outcome measures. Methods:A narrative literature review using Pubmed, Medline, Cochrane library databases and Google search engine is described.Results: From the literature review, patient-and surgeon-related risk factors and predictive models for conversion of laparoscopic cholecystectomy to open surgery were identified. Patient-dependent risk factors included preoperative and intraoperative variables. Current conversion of laparoscopic cholecystectomy to open surgery predictive models use only patient-dependent risk factors and were not tested on an independent sample of patients. Surgical quality outcome measures incorporate an association between conversion and intra-abdominal organ injury that demonstrates that conversion was used as an emergency strategy to repair injuries rather than a safety measure. Conclusion:Conversion of laparoscopic cholecystectomy to open surgery risk stratification based on patient-and surgeon-dependent variables may allow a better management of the patient to keep conversion at low rates and to maintain benefits of minimally invasive surgery.

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Advanced laparoscopic fellowship training decreases conversion rates during laparoscopic cholecystectomy for acute biliary diseases: A retrospective cohort study

Abstract: Formal advanced laparoscopic fellowship training may decrease length of stay among patients presenting with acute biliary pathology who undergo laparoscopic cholecystectomy.

Cited by 29 publications

References 21 publications

Long‐Term Outcome and Complications Following Prophylactic Laparoscopic‐Assisted Gastropexy in Dogs

Long‐Term Outcome and Complications Following Prophylactic Laparoscopic‐Assisted Gastropexy in Dogs

Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

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