Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country

Abstract

INTRODUCTION:Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes.OBJECTIVE:The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC.DESIGNS AND SETTINGS:We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco.PARTICIPANTS:These operations were performed by junior residents (post-graduate year [PGY] 4–5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien–Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05.RESULTS:One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001).CONCLUSION:LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

“…In our study, factors found to be independently predictive of operative duration were patient age, gender, ASA grade, operative indication, BMI, CBD diameter, gallbladder wall thickness, pre-operative CT scan, planned intra-operative cholangiogram and the number of previous surgical admissions. These factors are broadly similar to previous work by other researchers [ 12 , 20 , 21 ]. Our study expands on their work and has developed a clinically useful scoring tool.…”

“…These factors are broadly similar to previous work by other researchers [12, 20, 21]. Our study expands on their work and has developed a clinically useful scoring tool.…”

“…Zdichavsky et al [ 20 ] performed a retrospective analysis of 677 consecutive patients undergoing laparoscopic cholecystectomies from 2004 to 2007 (excluding conversions, intra-operative cholangiogram and concurrent liver cirrhosis) and found male sex, obesity, acute cholecystitis and previous abdominal surgery to be independently predictive of duration. In a small study of only 138 cholecystectomies, junior residents took significantly longer to complete a cholecystectomy than their senior counterparts ( p < 0.05) [ 21 ].…”

‘True Day Case’ Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay

“…Hence, we recommend that procedures longer than 90 minutes should not be a contraindication for same-day discharge. Previous studies have reported longer operating durations when trainees were involved [ 27 ]. However, the longer operating times in our cohort were not related to inexperience of the surgeon, as only two of the 38 prolonged operations were operated by trainee surgeons.…”

Evaluation of suitability of simultaneous laparoscopic surgery for the treatment of diseases of the hepatobiliary system

“…Зростання тривалості операцій у групі симультанних лапароскопічних операційних втручань, виконаних власною розробленою технікою, склав час, який не може конкурувати із тривалістю окремої повноцінної операції, якби їх виконували незалежно у різні періоди часу. Наприклад тривалість лапароскопічної холецистектомії у різних дослідників складає більше за отриману різницю, так само як і час, необхідний для виконання лапароскопічної холецистектомії у цьому дослідженні [16,17]. Також дослідники з інших публікацій вказують на часто переважаючий час, необхідний для створення доступу та зашивання ран, а також, при наявності злукового процесу під час повторної операції, для створення операційної зони [18].…”