The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor?

Abstract

<jats:title>Abstract</jats:title><jats:p>A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient.</jats:p><jats:p>Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy.</jats:p><jats:p>Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress.</jats:p><jats:p>Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.</jats:p>

Single incision laparoscopic fundoplication: A systematic review of the literature

“…Despite the advantages derived from laparoscopy, minimal invasive techniques require the completion, of a steeper learning curve by the operating surgeon, in order to be performed safely and efficiently[35-37]. Through systematic repetition of the operative steps, the surgeon accumulates the necessary technical skills and achieves proficiency[36,37]. The clinical relevance of these, is that the operative volume and the location of an individual on the learning curve is directly associated with postoperative outcomes[38].…”

Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review

“…2 Subsequently, the concept of the learning curve was applied in the field of industrial manufacturing and software development. 3 In 1980, the learning curve was introduced in medicine and recognized as a parameter to assess professional responsibility. Recently, the concept of the learning curve evolved from a purely theoretical framework to a parameter upon which evaluating clinical outcomes such as mortality and morbidity.…”

“… 5 However, there is no definite guideline on how to measure the learning curve of this specific surgical intervention and literature is conflicting on the minimum number of procedures to perform to achieve proficiency and ensure a safe laparoscopic cholecystectomy. 3 The present systematic review aims to analyze the available literature about the learning curve of laparoscopic cholecystectomy. To our knowledge, there is no existing review on the topic performed with a systematic approach.…”

The Predictive Factors Associated with Longer Operative Time in Single-Incision Laparoscopic Cholecystectomy

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The predictive factors are beneficial to caution surgeons, especially those in residency training, and to determine the patient's prognosis before SILC surgery. 21…”