THE LAPAROSCOPIC LEARNING-CURVE

To characterize the learning curve for laparoscopic cholecystectomy, w e compared the first 47 cases (group A), which were performed by two s enior attending surgeons who assisted each other when the procedure wa s introduced into clinical practice (1990-1991), with the first 46 cas es (group R) performed by two surgical chief residents who were assist ed by members of the teaching faculty in 1992-1993. The patient groups were comparable in terms of age, sex, and anesthetic class, but patho logically proven acute cholecystitis was more common in group R (33% v s. 9%; p < 0.005). To analyze operative procedures and outcomes, we co mpared operative time, frequency of successful operative cholangiograp hy (attempted in all cases), frequency of conversion to open cholecyst ectomy, major complication rate, and days of postoperative stay for al l patients and for those without complications. Of these parameters, o nly operative time for nonacute cases differed significantly between t he groups (144 min for group A vs. 114 min for group R; p < 0.05). Com plications in group A included one ductal injury and one case of posto perative pancreatitis; group R had one ductal injury and two cases of postoperative bleeding. We conclude that (a) the learning curve has si milar structure for senior surgeons and resident trainees; and (b) the resident learning curve is not hazardous when teaching assistants are trained in the procedure, which has implications for safe instruction and proctoring of residents and staff.